Objective: The paper conducts in-depth research on the logic of the provincial-level overall planning risk adjustment system for basic medical insurance, comprehensively analyzes the advantages, potential risks, and implementation paths of this system, and provides support and decision-making references for the steady progress of provincial-level overall planning. Methods: Taking Guizhou Province as an example, the paper analyzes from dimensions of politics, economy, society, and technology with PEST analysis. Results: At present, the economic operation of the whole province is recovering and improving, and the basic medical insurance participation rate is stable at over 95%. However, there are still problems such as increased difficulty in raising basic medical insurance funds, high hospitalization rates, and significant differences in benefits among cities. Conclusion: It is recommended to take "unified benefits" as the core task, optimization of the population structure as an important goal, "coordinated development and regulation of medical insurance, medical services, and pharmaceuticals" as the key guarantee, and "unified financing and expenditure" as the ultimate goal, and focus on solving the problem of unbalanced and insufficient development in the medical insurance field, so as to promote the healthy and sustainable development of the provincial-level overall planning risk adjustment system, and strengthen the safety net of people's livelihood security.