Abstract
INTRODUCTION: The coordinated development of the digital economy and essential public health services is a critical issue for advancing the Healthy China initiative and promoting health equity. However, existing policy frameworks exhibit significant shortcomings in the design of cross-system collaborative governance tools and regional adaptability, thereby constraining the implementation effectiveness of the "digital health" strategy. METHODS: This study constructs an evaluation index system for the digital economy and essential public health services based on panel data from 30 Chinese provinces from 2012 to 2021. By employing a coupling coordination model and dynamic fuzzy-set qualitative comparative analysis (fsQCA), this study systematically reveals the interaction mechanisms and optimization pathways between the two systems. RESULTS: The key findings are as follows: (1) Temporal Trends: The degree of coupling coordination has undergone a phased transition from "on the verge of disorder" to "primary coordination." However, the overall growth remains limited, indicating an urgent need to shift from a "scale expansion" model to a "quality-driven" approach. (2) Spatial Patterns: A distinct regional disparity is observed, characterized by an "eastern leading, central catching up, and western lagging behind" pattern. Notably, 80% of provinces in central and western China remain constrained by digital economy-induced maladaptation. (3) Spatial Correlation: The coupling coordination degree exhibits significant positive spatial clustering characteristics. Provinces such as Anhui and Hubei in central China have achieved leapfrog development by leveraging technological spillovers. (4) Driving Mechanisms: The fsQCA results identify three distinct high-coordination configurations: the "digital infrastructure-driven" model in eastern China, the "government-human capital dual-driven" model in central China, and the "government-institutional environment synergy-driven" model in western China. DISCUSSION: These findings underscore the necessity for region-specific development strategies that align with local resource endowments and contextual factors. By adopting differentiated policy pathways, provinces can effectively promote the coupling and coordinated development of essential public health services and the digital economy, ultimately fostering a high-quality and sustainable integration of the two systems.