Since July 1，2009，“rules for co-ordinate general out-patient medical costs of Guangzhou city basic medical insurance（Trial）” has been formally implemented. It succeeded in improving efficiency in the use of fund and individual account，promoting the efficient utilization of medical service resources and so on. The out-patient rules has played a very positive role especially in the management of outpatient expenses control. To a certain extent，it curbed the excessive growth of medical care costs and achieved certain good results through setting a limit by means of settlement average per person per year. But for the 2011 annual liquidation，Medical Insurance Administration Bureau of city discovered a very outstanding phenomenon：grassroots medical institutions’ outpatient expenditure exceeded the limit standard more greatly than other medical institutions.

This thesis aims at choosing right adjustment measures by researching the inner and outer circumstance of grassroots medical care institutions. By comparing the data of the last three years，we found the characteristics of over-limit fees in grassroots medical institutions including the policy，social and economic environment factors and the insured medical behavior，the hospital itself and put forward several countermeasures accordingly.