To promote the provincial pooling of basic medical insurance, it is necessary to find a feasible way according to the situation of each province. Based on the analysis of the implementation paths of some provinces, this study proposes that there are two pooling modes of provincial pooling, i.e. horizontal equity and vertical equity. A representative province is selected to take employees’ medical insurance as the research object. After comparing and analyzing the two modes through current situation investigation, policy summary, data analysis and evaluation, it is concluded that compared to horizontal equity, the provincial pooling mode based on vertical equity is more suitable for provinces with large differences between cities. This study focuses on the implementation path of provincial pooling based on vertical equity, introduces the adjustment fund extraction and allocation methods and related factors systematically, and puts forward the problems that may be encountered in the implementation process, as well as relevant countermeasures and suggestions for reference.