In the paper，achievements of and problems in the China’s social medical insurance system as of the reform and opening-up were analyzed，and suggestions were given on its reform. As stated in the paper，the achievements were the realization of socialization and responsibility sharing，maintaining of social stability and continuous improvement in security level simultaneous with stable income and expenses of funds；the problems were low security level，non-coverage of minor illness，systemic separation，low efficiency of personal account，absence of coerciveness，unsatisfactory expense control and absence of systems of first diagnosis，referral and hierarchical diagnosis. It is suggested that diversified measures shall be taken in the future，such as cancellation of personal accounts，insurance in the unit of family，classified lifetime payment for retirees，unification of public medical fund management institutions，reform of payment mode and systems of first diagnosis，referral and hierarchical diagnosis.