The paper discusses the historical development of Guangzhou’s medical insurance system by summarizing characteristics of the system，including the sub-system of employees’ medical insurance，medical insurance for urban residents and new rural cooperative medical system. Combined with Guangzhou’s socio-economic situation，the paper points out challenges confronting the current medical insurance system，including aging population，sustainability of medical insurance fund and management of medical institution. Finally，the paper tries to project the future of Guangzhou’s medical insurance from the convergence of sub-system and payment schemeect.