Objective: To understand the status of the hierarchical medical of elderly patients in Huaian city and explore how to scientifically implement. Methods: To sampling survey a tertiary referral center and primary care institutions over the age of 65 elderly patients with medical information in Huaian City in 2014 and 2015, and analysis and comparison of the top twenty diseases of main diagnosis and cost. Results: Elderly patients with the tertiary referral center were mainly concentrated in the tumor (including chemotherapy) and cardiovascular and cerebrovascular diseases, the primary care institutions were mainly cardiovascular and cerebrovascular diseases. In addition to the average hospitalization expenses of the primary care institutions were approximately 1/3 of the tertiary referral center, and the average variation of the average hospitalization expenses among different types of diseases. Conclusion: The tertiary referral center should change the concept of development, improve the proportion of difficult and critical cases; to strengthen the implementation of the primary diagnosis system, improve the acute and chronic treatment, two-way referral;