Promoting provincial-level pooling of basic medical insurance is an important measure to improve the risk resistance and mutual aid of medical insurance funds. Based on the policy text of the provinces that have realized the pooling of basic medical insurance at the provincial level, this paper analyzes the current situation of the pooling at the provincial level from the pooling mode, fund raising, fund allocation, risk and responsibility sharing and performance appraisal mechanism, and discusses the problems and prospects of the pooling at the provincial level on this basis. The results show that the provincial-level pooling practice of basic medical insurance in different provinces had significant differences in many aspects. Improving the pooling level is helpful to promote the balanced medical insurance benefits and break the restrictions on medical treatment, but the problems of provincial-level pooling are not conducive to the implementation of pooling policies and the realization of pooling objectives. We should reasonably evaluate the implementation conditions of pooling policies, promote the unification of pooling policies and claim management and fund administration systems, learn from international experience to improve the risk adjustment mechanism and coordinate the reform of supporting measures to enhance the level of pooling.