OBJECTIVES: The study aimed to compare the direct medical cost difference of hemorrhagic stroke inpatients with different types of health insurance from 2010 to 2012 in China. METHODS: A nationwide, cross-sectional sampling of hemorrhagic stroke inpatients with disease code ICD-10 (I60,I61,I62) with basic medical insurance scheme for employees (BMISE) and basic medical insurance scheme for urban residents (BMISUR) was extracted from the China Health Insurance Research Association claim database. A retrospective analysis was adopted. RESULTS: The inpatients number of BMISE was 5321,the inpatients number of BMISUR was 1510. The average age was 63.08 and 62.34 years, respectively. Patients with BMISE went to third-level hospitals, second-level hospitals and under second-level hospitals accounted for 57.01%, 33.71% and 9.27%; but for BMISUR, the percentage of distribution was 48.94%, 37.76% and 11.31%. From 2010 to 2012, the average hospitalization expenses of each visit with BMISE was 25575.34, 24219.22 and 26889.57 yuan; For BMISUR, the expenses of each visit was 21211.57, 18999.53 and 19088.96 yuan. Reimbursement by BMISE in 2010, 2011 and 2012 was 71.01%, 74.12% and 68.25%; while the reimbursement by BMISUR was 45.95%, 53.49% and 51.16%. CONCLUSIONS: The insurance level difference between two health insurance schemes influences the treatment regimens and benefits received by patients. People prefer to go to third-level hospitals, but people with BMISE has higher proportion than people with BMISUR, about 10%. For the people with BMISUR, the out-of-pocket  spending was 50% of total expenses, needing to raise reimbursement rate, setting up differentiated reimbursement for different income level groups. From 2011 to 2012, the reimbursement rate declined slowly, we need to study the cause in the future.