The digitization of Electronic Medical Record (EMR) provides potential access to a wealth of medical information, but also presents new challenges in privacy-preserved EMR exchanging and sharing. In this paper, we propose a blockchain-based smart healthcare system with fine-grained privacy protection for reliable data exchanging and sharing among different users. We design a blockchain-enabled dynamic access control framework combined with Local Differential Privacy (LDP) strategies to provide the attribute-based privacy protection in transaction workflow. We design four types of smart contracts in the framework to meet the requirements of anonymous transaction, dynamic access control, beneficial matching decision, and evaluation of published data in an open network. To satisfy fine-grained privacy protection, we classify sensitive attributes of EMRs into different levels and set differential privacy budgets to randomize attributes before data publishing. Also, we design data quality function to depict the disturbance incurred by LDP-based privacy preferences at the requester view, and present appropriate many-to-many matching decisions among participants for beneficial transactions. Finally, we develop a prototype system and test our approach using 200,000 real-world EMRs. Experimental results show that the proposed privacy-preserved scheme can make stable and reliable transactions between EMR publishers and requesters. The prototype system achieves individual-centric privacy configuration at the patient site, while providing error-guaranteed statistics at the requester site. Additionally, the access control policies, logs of anonymous transaction are kept in the blockchain to provide system-level traceability.