Abstract: Objective To evaluate the utilization of the New Rural Cooperative Medical System(NRCMS) and its related factors among elderly rural residents and to provide evidences for the improvement of NRCMS.Methods Using stratified random cluster sampling,913 rural residents aged 60 years or older were selected from 8 municipalities in Guangdong province and surveyed with a self-administered questionnaire under the help of interviewers in 2014.Descriptive statistics and chi-square test were adopted in data analyses with SPSS 19.0.Results Among the 793 participants with eligible response,617(77.8%)participated in NRCMS,of which,591(95.8%)reported the willingness to participate the NRCMS continuously.Of the 617 participants under the coverage of NRCMS,only 266(43.1%)had used NCMS to apply for medication reimbursement,of which 121(45.5%)utilized NRCMS for their hospitalization cost reimbursement.Of the 145 participants with the reimbursement of outpatient medication cost,40.7% got their medical service at township healthcare centers and 35.9% at hospitals of county level or above;of the participants with the reimbursement of hospitalization cost,58.2% had their hospitalization in hospitals of county level or above.Among the 351 participants who covered by NRCMS but did not had reimbursement for their medication cost,237(67.5%) reported the unawareness of the reimbursement policy of NRCMS.The medication cost was decreased among 86.5% of the NRCMS participants.The satisfaction to NRCMS was correlated with the decrease of self-paid medication cost and medication cost reimbursement of NRCMS among the participants(P<0.001).The higher satisfaction to NRCMS was observed among the participants with reimbursement or decrease of self-paid medication cost compared to the participants without the reimbursement and the decrease of the cost.Conclusion The NRCMS decreased self-paid medication cost among rural elderly but the utilization of and the satisfaction to NRCMS among rural elder participants need to be improved.