Abstract: Objective： To examine the utilization and cost of outpatient care and their influencing factors among middle and aged peasant-workers in China. Methods: The data of China Health and Retirement Longitudinal Study (CHARLS) collected in 2011-2012 were used and the data on peasant-workers aged 45 years and older were analyzed with Two-part Model. Results: The four-week outpatient rate of middle and aged peasant-workers was 13.7% (407/2 974). The determinants of the rate included gender, marital status, economic level, household size, the place of insurance enrollment, self-assessed health and having or having no chronic diseases. The average outpatient cost was (400.3±56.7) yuan (RMB) and the median was 138.0 yuan. Multivariate analyses showed that outpatient costs were higher for those males who lived in Eastern China and worked at the same place with insurance enrollment, with fair to bad self-assessed health and chronic diseases. Conclusion: Allowing higher flexibility for migrants to transfer the new rural cooperative medical system(NCMS) between rural and urban areas and thus making reimbursement for medical services provided by undesignated providers received immediately could increase the use of outpatient services.