Abstract: With the continuous development and expansion of cities under the rapid urbanization, the accessibility of urban medical facilities, as the core part of the urban public service system, changes accordingly, and the fairness and equality of medical service space in single core small and medium-sized cities are most affected. Taking Xinyang urban area as an example, based on ArcGIS spatial analysis technology platform and two-step mobile search method, the accessibility evaluation and spatial optimization of medical services are intensively studied. The results show that the distribution of high-grade medical facilities in Xinyang urban area is too concentrated, and the distribution of low-grade medical facilities is unbalanced. With Hudong street and High-tech Zone as the core, the accessibility level is significantly different from Gaoliangdian Township, Chashan Township and Hudian township; The accessibility level of medical facilities is positively correlated with population density and traffic conditions, but negatively correlated with regional altitude. Through the optimization simulation, it is suggested that Pingqiao Minggang Hospital of traditional Chinese medicine and Xinyang Second People's hospital should be upgraded as the third level hospitals, so as to improve the accessibility of medical services in Xinyang urban area as a whole.