Objective To explore the problems and influencing factors of the design of medical insurance system in Heilongjiang Province by factor analysis. Methods Through literature survey and investigation to establish questionnaire and conducting investigations, with the survey data used SPSS package for factor analysis. Results The four common factors derived from factor analysis reveal the key issues that hinder medical insurance system design.First,the fairness factor is driven by the imbalance among fund raising,financing and payment standard and degree of insurance coverage.Second,the failure management factor is affected by present ineffective supervision of medical insurance system and inappropriate interior design of management system.Third,insurance mode factor mainly refers to the effect that individual insurance made has exerted on the medical insurance system implementation .Fourth,the system connecting factor involves the ill-connection between medical insurance system and health system. Conclusion Medical insurance reform should center on the striking issues in medical insurance design,improve related system design and quicken the reform design in present management system,supervision and evaluation.Besides special attention should be paid to the connecting system between medical insurance system and health system.Individual insurance mode and other related areas should be perfected. With all these,the aim of all citizens medical insurance will be realized.