Objective: The paper attempts to alleviate the problem of "difficult and expensive medical treatment" for the middle-aged and elderly in China by analyzing the influence of direct settlement for transprovincial healthcare on the medical economic burden of the middle-aged and elderly. Methods: Based on the hospitalization reimbursement data of medical insurance for middle-aged and elderly employees in a certain hospital in city A of China from 2020 to 2021, the treatment effect model and intermediary effect model is used in this study. Results: The immediate reimbursement for transprovincial healthcare alleviates the economic burden of the middle-aged and elderly to a certain extent. The implementation of immediate reimbursement for transprovincial healthcare has improved the accessibility of medical resources and medical insurance for the middle-aged and elderly participants of basic medical insurance. Supplementary medical insurance for employees plays a significant intermediary role in the process of immediate reimbursement alleviating the burden of the middle-aged and elderly people, and the intermediary effect accounts for 34.4%. Conclusion: The government should implement the medical insurance policy of immediate reimbursement and further play the role of supplementary medical insurance for employees in the medical expenses of transferred patients with serious illness, carry out grading diagnosis and treatment through the construction of medical union and grass-roots general practitioners.