PURPOSE: In the midst of rapid ageing population and rising medical cost, smoking cessation policy is more emphasized by the governments in China than ever. They have taken a public health approach to reform their medical care system, in which policy under an innovative public health reform process is hammered out to reduce the impact of ageing population and rising prevalence rates of chronic diseases on medical expenditure. However, there are very limited studies on the relationship between China's medical care system and elderly smoking behaviors. DESIGN/METHODOLOGY/APPROACH: The study adopts national elderly data, namely the China Health and Retirement Longitudinal Study (CHARLS), to investigate into the relationship between medical care system and elderly smoking behaviors with control variables, including socio-economic background, disability status and chronic diseases. FINDINGS: According to the results of logistics regression model, there is no significant relationship between smoking behavior and the medical insurance for urban residents and urban employees, whereas new rural cooperative medical insurance is positively correlated to the likelihood of smoking and negatively correlated to the likelihood to quit smoking among the elderly population. Besides, aged above 75, having chronic diseases and visual disability increase the likelihood to quit smoking, but no formal education and hearing disability decrease the likelihood to quit smoking. Aged above 75 and married lower the likelihood of smoking, but male, having hearing disability and respiratory disease enhance the likelihood of smoking. ORIGINALITY/VALUE: China's medical care system has not yet fully utilized its role in public health approach and the governments may modify their smoking cessation policies and practices to become preventive rather than reactive by taking reference to the findings of this paper.