Objective: The paper attempts to analyze the regional differences and spatial pattern evolution of resident medical insurance financing level in Shandong Province, and to provide countermeasures and suggestions for promoting provincial overall planning and narrowing regional differences. Methods: The Theil index was used to measure the regional differences in the level of resident medical insurance financing, and the spatial autocorrelation analysis method was used to explore the spatial pattern and evolution of the resident medical insurance financing level. Results: From 2015 to 2020, the Theil index showed a fluctuating upward trend, and regional differences were the main reason for the overall differences. The level of financing has local spatial autocorrelation. The center of the H-H hot spot in 2015 is Weifang, and it evolved into Yantai in 2020. The center of the L-L blind spot is stable in Jining. Conclusion: The regional differences in the level of resident medical insurance financing in Shandong Province are large and show an expanding trend. The regional differences between the provincial capital economic circle and the Jiaodong economic circle are the main reasons for the large overall difference. It is suggested that Shandong Province should implement the overall planning of residents' medical insurance within the regional economic circle and realize the regional integration of policies such as financing and treatment of residents' medical insurance.