We compared need for and utilisation of health services among young, healthy smokers who did not want to quit "the non-motivated", and "motivated smokers", relative to never-smokers. This cross-sectional study included 9915 Hong Kong police officers. We assessed smoking status, differentiating non-motivated from motivated smokers. Need was measured as the number of respiratory symptoms, and utilisation as the number of doctor consultations. All smokers had significantly more respiratory symptoms, but relatively lower utilisation. After adjusting for other factors, the odds ratio for utilisation was 0.77 (95% CI 0.64-0.93) for motivated smokers and 0.62 (95% CI 0.50-0.77) for non-motivated, relative to never-smokers (p for trend < 0.001). Young, relatively healthy smokers, particularly the non-motivated, utilise less health services relative to the amount of symptoms. This has implications for planning smoking cessation services.