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Background  The Second China National Sample Survey on Disability in 2006 showed that the participation rate of disabled Chinese rural individuals in social medical insurance participation was less than 30%. However, there has been limited number of studies on the influencing factors, especially contextual factors, affecting their participation in social medical insurance. Therefore, this study aimed to analyze the factors influencing the participation of disabled rural individuals in social medical insurance, including contextual factors.    Methods  Based on data derived from the Second China National Sample Survey on Disability, chi-square test and two-level logistic regression model were used to analyze the influencing factors.    Results  The results showed that the disabled rural individuals in the New Rural Cooperative Medical System pilot counties who lived in communities with rehabilitation stations or with higher per capita income of villagers were more likely to participate in the social medical insurance. Meanwhile, those employed, with less severe disability degree or with less severe barriers in participation in society were more likely to participate in the social medical insurance.    Conclusions  Contextual factors including economic and policy contexts were important factors influencing their participation in social medical insurance before 2006 in China. Unemployment, severer disability degree and social isolation might also prevent them from gaining equal access to social medical insurance.

Multi-level modelling of the factors that influence the participation of disabled rural individuals in social medical insurance in China