Objective: In order to promote the coordinated development and management of medical insurance，medical treatment and medicine，it intends to improve the comprehensive management and reform level of employee medical insurance through the analysis and research of the operational rules of hospitalization medical expenses under the new medical reform. Methods: Descriptive statistical analysis and Excel are used to analyze the operational rules and development trends of expenditure scale，structure，distribution，etc. Results: The cost of inpatient medical treatment continuous to increase and are concentrated in tertiary medical institutions. The cost of drugs has shown a downward trend，and the cost of diagnosis and treatment projects accounts for a relatively large proportion，which has increased year by year. The personal burden is heavy，and the aging is accelerating，resulting in increasing expenses. Conclusion: There are potential risks in the operation of the fund，and it is necessary to constantly improve the ability to resist risks. As medical expenses continue to rise，it is necessary to establish a more reasonable fee control mechanism. Hospitalization expenses show a clustered distribution，and the control of key medical institutions needs to be further strengthened. The medical cost structure shows new characteristics，and it is necessary to focus on strengthening the prices management of medical treatment items. The personal burden is still heavy，and the multi-level medical security system needs to be further improved.