Objective: To analyze the structural change of Shandong TEH before and after the Medical Reform for giving references to government decision-making and TEH monitoring. Methods: Methods including VSV, DSV, Contribution rate and Driving force were used in the analysis of Shandong composition of TEH before and after the Medical Reform. Results: The composition of OOP was better after the Medical Reform; Social health expenditure acted as key factor for TEH structural change; The gap of contribution rate between urban and rural residents’ OOP existed; After the Medical Reform, the social insurance acted as key factor for composition of TEH. Conclusion: Shandong Composition of TEH was better after the Medical Reform. However, the gap between urban and rural residents’ OOP should be eliminated.