The coverage of basic medical insurance has been continuously expanding, and its importance in safeguarding residents' health rights and interests has become increasingly prominent. The advance payment of basic medical insurance funds can effectively alleviate the financial burden of insured individuals. However, due to the simultaneous involvement of insured individuals' interests and the safety of medical insurance funds, this system faces a series of obstacles in both the advance payment and subrogation processes. These obstacles are mainly reflected in the difficulties faced by insured individuals in applying for advance payment and by medical insurance agencies in subrogation. This study explores dual paths for optimizing substantive rules and procedural mechanisms by analyzing the legal principles of the system, dissecting practical challenges, and drawing on foreign experience, to provide useful references for better ensuring the stable operation of basic medical insurance funds.