Objective To analyze the the current status and deficiencies of the county medical community construction policy and proposes policy recommendations to optimize the construction of the county medical community. Methods Based on the perspective of policy tools, a three-dimensional analysis framework was constructed combining policy evolution and stakeholder dimensions, and content analysis was used to quantitatively analyze the policy text in three dimensions. Results A total of 29 policy documents were included after screening. The overall utilization of policy tools showed an imbalance, with the utilization of capacity-type policy tools as high as 35.38%, but sub-tools such as financial investment (3.07%) and technical support(2.83%) were less used. Incentive-type policy tools were the least used, accounting for only 8.96%, with sub-tools such as price adjustment and promotion further education accounting for only 0.71% and 0.47%, respectively. The distribution of stakeholders was uneven, with primary medical and health institutions and county hospitals being the main targets, accounting for 27.77% and 25.52%, respectively. With the evolution of policies, the number and variety of policy tools used showed a rapid increase, but capacity-type policy tools still dominated, and there was an imbalance in the internal structure of policy tools. Additionally, the involvement of two key stakeholders including medical personnel and the public, was relatively low. Conclusion There is significant differentiation in the utilization of policy tools, with insufficient use of symbolic, incentive-type policy tools.It is suggested to improve the internal structure of policy elements, enhance the balance of policy tool utilization, continuously optimize policy tools, increase the use of incentive-type and symbolic policy tools, and strengthen the participation of two key stakeholders: medical personnel and the public.