Objective: To analyze the characteristics of medical treatment flow, disease types, expenses and other characteristics of cross-provincial medical direct settlement of rural insured population, and to understand the differences between different record types. Methods: Extract and descriptively analyze the direct settlement data of new rural cooperative medical care in Hainan Province from 2017 to 2019. The Kruskal Wallis H non-parametric test and Chi-square test are used to test the differences in the expenses and disease types of different record types. Results: The cross-provincial rural insured population in Hainan Province showed the characteristics of concentrated inflow areas, major referrals for serious diseases, and a large proportion of cancer patients. The hospitalization expenses, medical insurance payment expenses and medical insurance reimbursement ratios of patients referred for serious diseases were higher than those of patients who lived and worked in different places for a long time (p<0.05), while the difference between patients who lived and worked in different places for a long time was smaller. Discussion and suggestions: Different types of cross-provincial peasant groups seeking medical treatment should be managed by classification. For peasant groups who live or work in different places for a long time, the inflow areas should formulate supporting medical, educational, vocational, and public service systems to protect their rights and interests. Outflow areas should strengthen the construction of local medical service system and improve the level of medical and health services At this stage, relevant government departments should take the record policy as the point to verify the type and treatment of patients, improve the level of refined management, and ensure the rational use of funds.