Abstract: Objective To examine the utilization and cost of inpatient care and their influencing factors among the elderly in rural China and to provide evidences for rational utilization and cost control of inpatient care. Methods The data of China Health and Retirement Longitudinal Study（ CHARLS） collected in 2011- 2012 were used and the data on the elderly of 60 years and older in rural China were analyzed. Results The hospitalization rate of the elderly was 11. 44%. The determinants of the rate included residential area,economic level,health insurance,self-reported health, smoking,and whether having chronic disease. The average hospitalization cost was 6 269. 29 RMB yuan and the average daily cost was 599. 14 RMB yuan and the average individual cost was 3 914. 76 RMB yuan. Multivariate analyses showed that the determinants of utilization of inpatient care included living in central and west area,good economic level,having urban basic medical insurance,having bad self-assessed health,smoking,and having chronic diseases. Multiple linear regression analysis showed that the hospitalization expenses was higher among those who had better economic level,hospitalized in higher level medical institution,more days in hospital,having a surgery and the expenses was lower among those who lived in the central and west area. Conclusion Raising the economic level and the coverage of health insurance could increase hospitalization. Shortening hospitalization days and rationalizing the distribution of inpatients in different hospitals were the key points to control costs and alleviate financial burden of the elderly.