The study main purpose to understand the burden of medical expenses of the poor patients in the four fixed?point poverty alleviation countries since the implementation of health poverty alleviation， and to explore the effects and shortcomings of the implementation of health poverty alleviation. By comparing the medical expenses， the composition of medical expenses sharing， and the difference expenses of the hospitalization and outpatient in the poverty?stricken population in the four depth poverty?stricken countries from 2016 to 2018. It is found that the implementation of the health poverty alleviation policy has achieved results in poverty reduction and medical costs control. There are significant differences in medical expenses of the poor patients in different years and different regions. The total medical expenses are on the rise， and the burden of personal out?of?pocket expenses has not increased. The compensation for medical expenses is mainly based on the new rural cooperative medical system（NCMS）， medical healthcare insurance fund is under pressure， and other compensation effect is not obvious. Secondly， the number of chronic disease patients is increases， and it costs accounted for 64.66% of the total medical costs. It aggravated the state of disease. It is recommended to strengthen the role of the health poverty alleviation policy， improve the precision and fairness of the medical security policy for the poor patients， and reduce the burden of disease and improve the sense of contentment of the poor patients. Strengthen the cooperation with other charitable organizations， stabilize the funding channels， improve the protection mechanism for major diseases， improve the effectiveness of classified treatment， enhance the health management of chronic diseases in rural areas，and the construction of the primary health institutions.