The provincial pooling of basic medical insurance under the adjustment fund mode is the best choice in the initial stage because of its low risk, easy operation, taking into account regional mutual aid, risk management. Based on the data of the2021Analysis Report on the Operation of Medical Insurance in Guizhou Province, this study designed the centralization, allocation mechanism of the adjustment fund system. By explaining the adjustment mechanism, clarifying the adjustment logic, the adjustment effect was demonstrated. Firstly, the adjustment fee is divided into basic adjustment fee, additional adjustment fee. The basic adjustment fee is extracted at the proportions of5%, 8%, 10%. Secondly, the combination of deficit adjustment, assessment adjustment is carried out, during the implementation of the two mechanisms, dependency ratio, regional population aging rate is introduced respectively to eliminate the impact of uneven regional fund burden due to population aging. Finally, after comparing the cost, benefit of adjustment under the three proportions, it is concluded that the scheme of5% adjustment fee is the optimal scheme. On this basis, the characteristics of adjustment fee system in Guizhou Province are summarized, the matters needing attention in the implementation of adjustment fee overall planning in Guizhou Province are clarified. This study can provide reference for provinces, cities that will implement the provincial pooling system of adjustment funds, improve the scientificity, robustness of the reform