The basic medical insurance of our country established the employee insurance covering all employment population of medical insurance for urban workers through the reform the planned economy of the relying on company，holding on the principle of the “low level，wide coverage” the medicare population expanded to urban and rural residents’，and display the social function gradually. In improving the benefit of the medical insurance，permit the mechanical insurance agency to carry out the business beyond the basic medical insurance resulting the patients with heavier economic burden，which greatly activates the medical insurance market. At the same time，to meet the medical needs of the floating population，conduct the varied settlement account model immediately to access the medical care by the pilot，and explore the global budget payment reform to reduce the deficit of medical insurance fund. The basic medical insurance in China made great achievements while there are the following problems，because of the low level fund of the medical insurance，the service fragmentation is serious，personal account show the dysfunction in mutualaid，the medical insurance fund deficit risk increases，the negotiation mechanism miss between the payment party and the supplier’s party，the medical insurance payment reform lagging，all these existing in the institution and the management of the medical insurance impede the achievement of the national health insurance. Therefore，improving the fund level of medical insurance，and gradually eliminating the gap of the urban and rural medical insurance system，improving the benefit equity and appeal of medical insurance to achieve universal health care ultimately. In controlling medical expenses，through the medical payment reform to improve the medical service market，not only implement the government and medical insurance agencies，but also the separation the government and public hospital，the establishment of medical care and medical service price negotiation mechanism，in the control of the medical expenses while continuous improvement of medical service quality，balance interests between supply and payment，so that male the medical insurance sustainable development.