Objective: To explore the hypothesis that better health status of elderly populations is primarily determined by the provision of freely accessible health service at low or no cost to the user and a social welfare system. Method: Information was collected by questionnaire from surveys of three cohorts of elderly (70 years and older) Chinese. Data from two health-care systems were compared: the low-cost or free government-subsidised system in Hong Kong, and the market-orientated user-pays system in urban (Beijing), and rural China. Results: The Beijing rural cohort had the best health profile, whereas the Hong Kong cohort had the worst, despite the better lifestyle practices in the Hong Kong and Beijing urban cohorts compared with the Beijing rural cohort, and higher socioeconomic status in the Beijing urban and Hong Kong cohorts. However, the Beijing rural cohort had the highest prevalence of functional limitations. Conclusion: While health-care systems may affect life expectancy at birth, psychosocial, lifestyle and socioeconomic factors influence subsequent health status of elderly people in a complex manner.