As the pioneer in health care reform，Guangzhou has taken the leading position in unifying the fragmented health care insurance systems in China. This paper gives a brief overview about the history of health care insurance development in Guangzhou during the past decades. Focusing on the policy process，it explores the role played by local governments and other influence factors which determine the progress and efficiency of health care insurance system unification in Guangzhou. Finally，Challenges which will be faced by Guangzhou in establishing a universal health care system are also proposed.