Objective To systematically review the practical approaches and outcomes of the development and reform modes for building a compact county⁃level medical community in Shanglin County, Guangxi. Methods Qualitative interviews and questionnaire surveys were conducted to understand the development and reform measures of the county⁃level medical community in Shanglin County, Guangxi. Quantitative analysis was performed on healthcare services, medical insurance fund flows, medical resource allocation, financial revenue and expenditure, and medical expense control at various levels of medical institutions before and after the reform of the county⁃level medical community. Results The compact county⁃level medical community in Shanglin County, Guangxi achieved effective integration across organizational, professional, service, functional, and regulatory dimensions, yielding phased results in the construction of the healthcare service system: (1) from 2017 to 2022, Shanglin County depicted an overall increasing trend in total number of medical visits, the proportion of outpatient and emergency visits at primary⁃level medical and healthcare institutions, and the number of telemedicine service visits. The number of patients referred from higher⁃level hospitals to primary⁃level medical and healthcare institutions first increased and then decreased, whereas the number of referrals from primary⁃level medical and healthcare institutions to higher⁃level hospitals decreased first, then increased and then decreased. Since 2020, the county⁃level medical community began to establish a telemedicine service system. In 2021 and 2022, the number of telemedicine service visits was 8087 and 4772, respectively, with a growth rate of -40.99%. (2) From 2020 to 2022, the rate of visits within Shanglin County decreased slightly but remained at a relatively high level overall. During the same period, the proportion of medical insurance funds allocated to primary⁃level medical and healthcare institutions increased year by year, the county⁃wide expenditure rate of medical insurance funds and the per capita hospitalization expenditure of insured personnel interpreted a downward trend year by year. (3) From 2017 to 2022, the number of beds, the number of equipment units valued at over 10 000 RMB, the number of health technicians, and the number of patients with chronic diseases under standardized management of primary⁃level medical and healthcare institutions in Shanglin County at various levels all demonstrated an overall increasing trend. (4) From 2017 to 2022, the total revenue, medical revenue, and total expenditure of medical institutions at various levels in Shanglin County indicated an overall increasing trend. The proportion of personnel expenses to operating expenses in leading hospitals and the proportion of fiscal subsidy income to total revenue in primary⁃level medical and healthcare institutions expressed an overall decreasing trend. (5) From 2017 to 2022, the per capita outpatient expenditure and the per capita hospitalization expenditure of patients at medical institutions at various levels in Shanglin County revealed an overall growth trend. Conclusion The overall operation trend of the county⁃level medical community in Shanglin County, Guangxi, is positive, with increased utilization of primary healthcare services, increasing health resources year by year, and the return of patients and medical insurance funds to the primary level. However, improvements are still needed in the construction of hierarchical diagnosis and treatment, information platform operation, and the coordination of medical insurance policies.  

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