In 2021，the number of participants in China’s basic medical insurance exceeded 1.36 billion，the fund’s income and expenditure were in good condition，and the benefits were further improved. Progress in the reform of the basic medical insurance system includes：the quality of medical insurance participation was further improved；the reform of centralized purchase of medicine，drug catalog and price adjustment were promoted in an orderly manner；the reform of DRG/DIP payment method was carried out in an all-round way；the strong efforts of medical insurance fund supervision continued to consolidate；the standardization and informatizaiton of medical insurance were carried out in depth；medical insurance measures for pandemic prevention and control continued to be optimized. The problems and challenges faced by the development of basic medical insurance system include：the accuracy of basic medical insurance participation still needs to be improved；the related mechanism of benefits receiving and financing needs to be improved；the reform of medical insurance payment mode needs to be further promoted；the challenges facing medical insurance fund regulation is still severe；the construction of medical insurance informatization needs to be further strengthened. The development paths of the basic medical insurance system include：building a fair medical insurance system，to improve the quality of basic medical insurance；building a secured medical insurance system，to optimize the benefit guarantee and financing mechanism；building a collaborative medical insurance system，to deepen the reform of centralized purchase system of medicines and medical insurance payment method；building a medical insurance based on the rule of law，to improve the medical insurance fund regulatory system；building smart medical insurance system，to accelerate the informatization and standardization of medical insurance system.