Objective  To examine health service demand and utilization among rural residents aged ≥ 60 years in Hebei province.

  Methods   Using stratified multistage cluster sampling, we conducted face-to-face interviews among 2 892 residents ≥ 60 years in 12 villages of 3 municipalities, Hebei province during July – September 2019. A self-designed questionnaire was used to collect participants′ information on health service demand, utilization and accessibility.

  Results  Among the participants surveyed, the prevalence of chronic diseases was 79.1%; the two-week prevalence rate was 20.5%; 12.4% reported ever visiting a doctor during past two weeks; 34.4% reported with illness to be treated but not seeking medical service during past two weeks; 26.6% reported having hospitalization during previous one year and 46.8% reported with diseases needing hospitalization treatment but not having hospitalization. The reported top three reasons for not seeking medication during past two weeks and not having a required hospitalization during past one year were self-perceived mild illness, economic difficulty, and inconvenient transportation. The difference in health service accessibility was statistically significant among the participants living in regions with different social development levels (P < 0.05); the participants′ health service demand and utilization differed significantly by some sociodemographic features (P < 0.05 for all).

  Conclusion  The health service demand is at a high level but the health service utilization is at a low level among rural elderly in Hebei province, suggesting that medical insurance and health resource allocation should be improved to promote health service utilization of the population.