The reform of medical insurance payment method is an important starting point for building hierarchical diagnosis. By sorting out the specific practices in the field of medical insurance payment reform in the construction of the "four separate" hierarchical diagnosis in typical domestic regions, it makes an in-depth analysis of the limitations of the medical insurance payment reform, and proposes ways to speed up the construction of a hierarchical diagnosis, so as to help the high-quality development of the construction of the hierarchical diagnosis and treatment system during the "14th Five-Year Plan" period.