Objective: By analyzing the operation of basic medical insurance in Guangxi from 2017 to 2021, the paper provides suggestions for the sustainable and healthy development of medical insurance fund in Guangxi. Methods: Based on the data of basic medical insurance in Guangxi from 2017 to 2021, the paper applied SPSS software for statistical analysis. Results: From 2017 to 2021, the number of employees participating in medical insurance in Guangxi continued to increase, with an average annual growth rate of 6.45%, while the number of residents participating in medical insurance decreased slightly, with an average annual growth rate of -0.45%. The income and expenditure of the medical insurance fund for employees and residents were increasing. The average annual growth rate of income and expenditure of the medical insurance fund for employees was 13.27% and 14.82%, and the average annual growth rate of income and expenditure of the medical insurance fund for residents was 8.62% and 18.84%. The balance rate of the medical insurance fund for employees and residents was decreasing year by year, from 24.03% and 28.55% in 2017 to 19.77% and -2.4% in 2021. The average hospitalization expenses of employees and residents increased year by year, with an average annual growth rate of 2.51% and 8.83% respectively. Conclusion: The balance rate of employees' and residents' medical insurance fund has slightly decreased, resulting in high pressure on the operation of funds. It is urgent to establish a long-term mechanism for the supervision of medical insurance fund, and improve the efficiency of fund use by various means.