The development of urban-rural medical assistance system in Guangzhou has gone through a process of institutional construction and modification. At first，the article shows us a historical overview of the growth of medical assistance system in Guangzhou. Then，we evaluate the performance of the system based on dimensions such as institutional construction，assistance management，coverage and accessibility. Besides，the authors also analyze key issues which exist in the process of system construction. Furthermore，we explore major constraints on further improvement of the system，and those constraints mainly include that：the idea of medical assistance has been lagging behind；the design of the system is unreasonable；effective connecting mechanisms between medical assistance system and other related systems haven’t been built yet；the management of medical assistance is lack of efficiency and few attention is paid to the quality of service delivery. Finally，we draw some lessons from the development of medical assistance system in Guangzhou，and several policy directions the government may take in the future are discussed.