This study discusses the operation status and implementation effect of basic medical insurance fund for urban employees in Guangxi. The results show that from 2018 to 2022，the operation of the urban employee medical insurance fund in Guangxi is overall positive，the number of employee medical insurance participation，fund revenue and expenditure maintain a stable growth trend，with an average annual growth rate of 5.60% ，13.44% and 12.92% ，respectively. The number of people receiving treatment under medical insurance has gradually rebounded. The average hospitalization cost per visit steadily dropped，and the hierarchical medical treatment system has become increasingly evident in the proportion of medical expense reimbursement. In general，it is necessary to focus on optimizing the structure of employee medical insurance participation，expanding the funding sources，steadily promoting the outpatient mutual - aid mechanism， improving the efficiency of fund use，establishing and improving the regularized supervision mechanism. By implementing these measures，we aim to provide a reference basis for promoting the stable and sustainable operation of the basic medical insurance fund for urban employees in Guangxi.