Objective  To compare mitigating effect of community medical service and the New Rural Cooperative Medical Scheme (NRCMS) on economic burden of disease among rural left-behind elderly and the elderly moving to urban areas.

  Methods  We extracted the data on NRCMS-covered 7 168 rural residents aged ≥ 60 years from a cross-sectional dataset of Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in various rural China in 2014. Analysis of variance, chi-square test, and logistic regression analysis were adopted.

  Results  Of the participants, 34.28% (2 457) reported the intention to leave rural residence and 65.72% (4 711) to stay in countryside. Compared to the left-behind elderly, the elderly being moved to urban areas had a significantly higher household income (P < 0.001) and a better accessibility of medical service (P = 0.009 4) but a similar medical expenditure (P = 0.598). The mitigating effect of community medical service and the NRCMS on economic burden of disease was significantly higher among the rural elderly in eastern rural China than that among those in central and western rural China (P < 0.05) and the mitigating effect was limited among the rural elderly living alone and the disabled elderly (P > 0.05).

  Conclusion  There are obvious diversities in both the quality of medical insurance and community health care and the mitigating effect of community medical service and the NRCMS on economic burden of disease among the elderly in different areas of rural China. Improvement of community medical service and medical insurance will play important roles on the wellbeing of rural left-behind elderly and on the intention of endowment pattern among rural elderly.