Aiming at the problems of difficult medical treatment for urban residents, low efficiency of hospitals, imbalance of medical resources and difficulty to meet the demands of patients, this paper proposes an urban intelligent medical service system based on multiobjective decision-making optimization strategy. Firstly, it analyzes the medical service demands of urban residents and points out that the urban intelligent medical service system should provide comprehensive services for residents; the main demands include basic medical demands, expected medical demands, and health care medical demands. Secondly, based on demand analysis, an urban intelligent medical service system composed of government, community hospital, large hospital, and urban residents is designed. The system has three kinds of system functions: customer business services, basic services, and institutional information services. Then, the overall process of the system before and after treatment of urban residents is introduced. Finally, according to the optimization objectives of the system: low medical cost, fast treatment speed, and high service satisfaction, the corresponding optimization strategies are formulated to optimize the urban intelligent medical system, reduce medical cost, improve treatment speed, and improve customer satisfaction, to better serve urban residents.