Objective: The paper analyzes the structural imbalance in medical assistance expenditure between inpatient and outpatient services for disadvantaged groups in Guangxi, and explores assistance differences across identity groups, providing a reference for optimizing fund allocation. Methods: Data on outpatient chronic and special disease and inpatient assistance for subsistence allowance recipients and extremely poor individuals across 14 prefecture-level cities in Guangxi (2022-2024) were collected. Descriptive statistics, t-tests, ANOVA, multiple linear regression, and linear mixed models were employed. Results: (1) Per capita inpatient assistance (1585.67±196.63 yuan) was significantly higher than outpatient assistance (185.54±71.53 yuan), approximately 8.5 times as high (P<0.001). (2) No significant difference was found in overall assistance between the two groups (P>0.05), but the interaction between care type and identity group was significant (β=0.754, P<0.001): extremely poor individuals received higher inpatient assistance while subsistence allowance recipients received higher outpatient assistance. (3) No significant annual differences were observed across 2022-2024 (P>0.05), with robust mixed model results. Conclusion: Medical assistance in Guangxi is relatively balanced, yet prioritizes inpatient care to the disadvantage of the extremely poor in outpatient services. Assistance levels have remained stable over three years, though intercity disparities are widening. Recommendations include raising assistance standards of outpatient chronic and special disease, exploring a graded scheme linked to care types, establishing a dynamic adjustment mechanism for assistance standards, and gradually narrowing the gaps in security levels within the assistance groups and across regions.