A social health insurance (SHI) program has been established in China to ensure that people can obtain health care economically and equitably. Our analysis indicates that in 2005-06, 66.5 percent of Chinese citizens were non-SHI inpatients. We also found that drug spending for SHI inpatients was significantly higher than that for non-SHI inpatients. After adjusting for other variables, we found that the SHI coverage was also associated positively with higher drug costs. We present evidence to show that drug spending differences are attributable at least in part to differences in insurance courage.