This research links survey data from a large probability sample of the elderly population of one Canadian province with provincial insurance data documenting all their health care use during the years before and after the interview. The data show that “the elderly” are not high users of the health care system. Instead, a small proportion of those age 65 and older account for a disproportionately large share of service utilization. The study also identifies several predictors of high health-care use and discusses the implications of its findings for health care policy, practice, and research.