Abstract: Objective To investigate the demand and utilization of health service among rural people 60 years old or above in Ningxia Hui Autonomous Region (Ningxia) and to provide evidences for making health policy.Methods Totally 3 817 rural residents aged 60 years or older were selected with multi-stage stratified random sampling from 260 villages in 5 counties in Ningxia and a household survey was conducted among the elderly residents with a self-designed questionnaire in March 2015.Results The self-reported two-week prevalence of diseases was 25.1% and the prevalence of chronic diseases was 48.9% among the elderly residents.Of the elderly residents,11% reported visiting a doctor during the previous two weeks;of the elderly residents suffering form diseases and needing medical service during the two weeks,56.2% did not visit a doctor mainly due to self perceived mild symptoms or economic difficulties.Of all the elderly residents,24.9% had hospitalization and of the elderly residents needing hospitalization suggested by doctors,5.1% had no hospitalization during the previous one year mainly due to economic difficulties.Of the 1 868 elderly with chronic diseases,32.0% sought medication.The preferred medical institutions were hospitals at county level for the elderly visiting a doctor during the two weeks,having hospitalization within the previous one year,and seeking medication for treatment of chronic diseases.Conclusion The health status of rural residents 60 years old or above in Ningxia is not good and the demand and utilization of health service should be promoted among the population.