In 2020，the number of participants in China’s basic medical insurance exceeds 1.36 billion，the fund’s income and expenditure is in good condition，and the protection treatment is further improved. Progress in reforming the system：the work of medical insurance participation continues to improve，the reform of individual accounts for employees’ medical insurance is gradually promoted，the reform of medical insurance payment methods is deepened，the medical insurance outpatient coordination system is increasingly improved，and the supervision and management of medical insurance funds is strengthened. Problems and challenges facing the development of the basic medical insurance system：unbalanced and inadequate protection of treatment，the rationality of the financing mechanism needs to be improved，the multi-faceted composite payment method under the total budget management is not yet mature，the function of outpatient co-payment protection is not sufficiently played，and the supervision and management system of the medical insurance fund is not yet sound. Trends in the reform of the basic medical insurance system：further increase the overall level of the medical insurance system，improve the stable adjustment mechanism of funding and treatment，establish a manageable and efficient medical insurance payment mechanism，strengthen the outpatient coordination and co-payment guarantee mechanism，and improve the strict and powerful fund supervision mechanism.