Coupling Coordination Analysis of Medical Service Capacity, Residents' Health Level and Regional Economic Development in China.

Background: Synergistic development of the coupled and coordinated relationship of medical service capacity, residents' health level, and regional economic development (MRR) is crucial for realizing the "Healthy China 2030" strategy. This study aims to analyze the spatiotemporal features of the coupling coordination degree (CCD) of MRR. Methods: Based on panel data from 2012 to 2022, we constructed the MRR evaluation system. The entropy method was adopted to calculate the comprehensive index of each subsystem, and the coupling coordination degree model (CCDM) was used to evaluate the CCD of MRR during the study period. Furthermore, we applied exploratory spatial data analysis, the Dagum Gini coefficient decomposition, extreme gradient boosting (XGBoost) and Shapley Additive Explanations (SHAP) to explore spatiotemporal dynamic characteristics and factors associated with CCD. Results: (1) Throughout the study period, the overall value of the MRR composite system increased from 0.3798 to 0.4097, with an average annual growth rate of 0.54%. (2) CCD remained generally low, dominated by the basic coordination type. Both global and local spatial autocorrelation analyses revealed significant differentiated spatial clusters of high and low CCD, with the overall spatial distribution fitting a "high in the east, low in the west" pattern. Inter-regional gaps are the main reason for the overall differences. (3) In the full sample, Population density (PD)was the dominant external predictive contributor, with a mean absolute SHAP value of 0.028, followed by Internet broadband access ports (IBAP)and Government health expenditure (GHE). The key predictive factors differed among regions. Conclusions: This study clarifies spatiotemporal evolution and predictive contributors of CCD. These findings provide valuable insights for decision-makers to promote coordinated MRR development.