Objective To assess the level of direct economic burden of gastric cancer and provide basis for optimizing the allocation of resources and formulating the appropriate payment mechanism for diseases. Methods We collected the details of direct medical expenses for all patients (2322 people) with gastric cancer (ICD-10 disease code:C16.902) from January 1 to June 30, 2017 in the six counties based on the new rural cooperative provincial information system platform, and described the level of direct medical expenses, cost structure and compensation level. Result ①Hospitalization rate of patients with gastric cancer was 0.04% and hospitalization expenses accounted for 1.42% of the total cost of hospitalization for participant.②The number of hospitalizations in county-level and provincial-level medical hospitals accounted for 46.90% and 41.56%.③The average cost of hospitalization for gastric cancer was 11,294.31 yuan. The higher the hospitalization level, the lower the cost of hospitalization. ④Drug and material costs accounted for 17.29% and 22.97% of the total cost of hospitalization for gastric cancer respectively . The higher the level of hospitalization, the lower the proportion of drug costs. ⑤The actual compensation ratio for hospitalization of gastric cancer was 63.81%, and the actual compensation ratio for the poor population (91.24%) was higher than that of the general population (60.03%). Conclusions The hospitalization rate of the poor is higher than that of the general population, and county-level and provincial-level hospitals are the main institutions for the use of inpatient services for gastric cancer;Materials and medicines account for the main part of hospitalization costs for gastric cancer; There is a significant difference in the compensation level between poverty and the general population; From the perspective of the supply side, strengthening the inpatient service capacity of gastric cancer at the county-level medical institutions and establishing an effective referral mechanism for progressive patients can effectively reduce the direct economic burden of gastric cancer.