This paper uses descriptive statistical analysis method to analyze the operation of basic medical insurance for urban employees in Guangxi from 2018 to 2022, and 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 generally good, the number of employees insured and the fund income and expenditure maintain a stable growth trend, with an average annual growth rate of 5.60%, 13.44% and 12.92%, respectively, and the number of people enjoying medical insurance gradually rises. The average hospitalization cost remained stable and decreased, and the hierarchical diagnosis and treatment orientation was increasingly obvious in the proportion of medical expenses reimbursement. In general, it is still necessary to optimize the structure of employee medical insurance participation, expand the sources of financing, promote the steady implementation of the outpatient mutual support system, improve the efficiency of fund use, and establish and improve the normal supervision mechanism, so as to provide a reference basis for promoting the stable and sustainable operation of the basic medical insurance fund for urban employees in Guangxi.