Based on the 2018 data in the CMDS database, propensity score matching (PSM) was applied to study the impact of direct settlement for transprovincial inpatient medical expenses beyond the pooling district on inpatient medical expenditures. The study found that the implementation of the direct settlement for transprovincial inpatient medical expenses policy had no significant impact on the total inpatient expenses, and the impact on outof-pocket inpatient expenses was not stable, but it had a significant impact on inpatient reimbursement expenses. The regression coefficient showed that the per capita inpatient reimbursement expenses of the sample individuals would increase by 4009.45 yuan after implementing the policy. The implementation of the policy had a significant positive effect on inpatient reimbursement expenses. The findings above were still valid after robustness testing by replacing the explanatory variables. Based on the findings above, this paper proposes the following recommendations, including improving the responsivity and stability of the settlement system, further promoting the policy with high quality, rationally guiding patients to seek medical treatment in different destinations, and improving the overall utilization rate of medical resources in local places.