The current rules, regulations of the hospital financial accounting system are not perfect, resulting in non-standard medical financial accounting behavior, so related medical insurance problems cannot be processed in a short time. Hospital financial management has a direct impact on the running benefits of hospitals. Under the background of medical insurance reform, the hospital financial accounting system should be constantly improved. The professional skills, comprehensive quality of hospital financial accounting personnel need to be improved. It is necessary to cultivate financial accounting personnel who are politically, morally, professionally competent to meet the need of medical insurance, its development. Based on the requirements of the reform, development of the medical security system, this paper studies the current situation of hospital financial accounting, puts forward relevant suggestions