Objective: To analyze the reform measures and outcomes of the county-level medical alliance from the perspective of mixed policy tools. Methods: Taking Yangxi County in Guangdong Province as the object to carry out a case study，qualitative and quantitative data was applied to analyze the medical service capacity，medical resource utilization and patient flow before and after the reform of the medical alliance from 2017 to 2019. Results: Mixed policy tools have produced positive effects in the reform of county-level medical alliance. The authority and incentive tools optimized the internal resource allocation of the county medical alliance，and played a role in the control of medical expenses，the dual referral system，and the optimization of the medical service pattern. The capacity tools enhanced the comprehensive capabilities of the county medical alliance in terms of organization，management，resources，and services，which laid the foundation for the achievement of multiple goals. Meanwhile，the simultaneous use of multiple policy tools will inevitably lead to certain conflicts and tensions. In the county-level medical alliance reform led by local governments，excessive reliance on authoritative tools will restrict the effectiveness of incentive tools. Conclusion: Further reform of county-level medical alliance should make authority and incentive tools complement each other. Under the premise of rational de-administration，the government should give full play to the market incentives of medical insurance payment policies and develop learning policy tools，and strengthen the supervision and performance appraisal of the county-level medical alliance.