【Objective】 To analyze the situation of free blood use and direct reimbursement of blood expenses in Shiyan city, so as to provide basis for more effective service of free blood use and direct reimbursement of blood expense after blood donation, and recruitment and retain of blood donors. 【Methods】 The data of free blood use from 1999 to 2019 in Shiyan city were collected for statistical analysis. Measurement data were described by mean±SD, and enumeration data were described by rate or construction ratio. Chi-square test was used for comparison of construction ratio or rate of stratified groups. 【Results】 In the past 21 years, free blood use has developed from the overall increasing stage (1999~2014) to the overall stable stage (2014~2019). Free blood use accounted for 3.52%(40 722.11/1 156 307.85)of the blood donation. Among the blood recipients, blood donors themselves accounted for only 18.83%(2 240/11 898), far lower than the proportion of their direct relatives. Since 2013, Shiyan has carried out the direct reimbursement of clinical blood expenses of voluntary blood donors according to the unified requirements of Hubei Province. The direct reimbursement rate over the past 7 years was 76.49%(5 397/7 056), and the proportion of people from other cities who applied for reimbursement was 4.02%(284/7 056). 【Conclusion】 The policy of free blood use and blood expense direct reimbursement has promoted the development of blood donation. It can also be further improved by relaxing the reimbursement scope of free blood use, strengthening publicity, optimizing services, strengthening supervision, using WeChat public service platform to carry out remote free blood, and strengthening national network construction.