BACKGROUND: Meaning in life is not only a significant component of psychological well-being, but also a neglected issue with clinical importance that needs to be studied further, especially its association with health and healthcare utilization. OBJECTIVE: To study the level of meaning and its association with happiness, health and healthcare utilization among the elderly in Hong Kong. METHODS: A cross-sectional survey via telephone was conducted among 1000 elderly aged 60 years or above in Hong Kong. RESULTS: Higher level of meaning was associated with being quite/very happy, and better health status (better self-rated health status, less chronic illnesses, lower level of frailty, no limitation of activities) before and after adjustments. It was also associated with decreased likelihood of healthcare utilization (number of medications intake, hospitalization and Acute and Emergency (A&E) admission) before and after adjusted for socio-demographics. Path analysis showed that, the association of meaning with hospitalization, A&E admission and medication use was significantly mediated by health status among the elderly. LIMITATIONS: This cross-sectional study might not include all the potential associated factors and mediators. CONCLUSIONS: The sense of meaning is associated with happiness and may contribute to health and healthcare utilization among the Chinese elderly. Studies are needed to further look into the potential mechanisms. Meaning in life might be a promising interventional target for successful aging of the elderly.