Objective: The paper analyzes the operation and trends of basic medical insurance in Gansu Province from 2014 to 2021, and provides theoretical basis for deepening the reform of healthcare security system. Methods: Based on the basic medical insurance data of Gansu Province, SPSS26.0 was used for statistical analysis. Results: From 2014 to 2021, employees' medical insurance income and expenditure in Gansu Province both increased significantly, with average annual growth rates of 15.39% and 11.66% respectively, while the average hospitalization cost of employees' medical insurance generally showed a slow growth trend, with an average annual growth rate of 2.29%. From 2017 to 2021, urban and rural residents' medical insurance income and expenditure in Gansu Province generally showed a growth trend, with average annual growth rates of 10.64% and 7.37%, while the average hospitalization expenses of urban and rural residents are on the rise, with an average annual growth rate of 9.01%. Conclusions: At present, Gansu Province's basic medical insurance fund expenditure is under potential pressure, and the strength of grassroots medical insurance is relatively weak. We should promote the improvement of the regulatory system, improve the treatment guarantee system, and improve the efficiency of fund.