Objective To investigate the coordination status between provincial healthcare resource allocation and economic development level in China, identify key issues, and to propose optimization strategies. Methods Based on data from the China Statistical Yearbook and China Health Statistical Yearbook from 2020 to 2023, indicators for basic healthcare facilities, human resources in healthcare, healthcare services, as well as economic scale, economic effectiveness, and economic innovation development were selected. The entropy weight method, coupling coordination degree model, and TOPSIS method were comprehensively applied to analyze the coordination between healthcare resource allocation and economic development level in China. Results From the perspective of weight distribution, within the healthcare resource allocation assessment system, the weight of human resources in healthcare was the highest (0.4063) and continued to rise, while the weight of healthcare services decreased significantly. Within the regional economic development level assessment system, the weight of economic innovation development was the largest (0.3741). The weights of economic scale and economic effectiveness remained relatively stable over the four years, with minor fluctuations. There were significant differences in the closeness values of healthcare resource allocation and their interannual change rates between various provinces (autonomous regions, municipalities directly under the Central Government) in China from 2020 to 2023. The national average coupling coordination degree was 0.52, indicating an overall “barely coordinated” level, with weak interannual fluctuations, suggesting a low⁃level equilibrium state of the system. The coupling coordination degree in Eastern provinces (municipalities directly under the Central Government) like Beijing and Shanghai reached an intermediate coordination level, while Western provinces (autonomous regions) like Xizang and Qinghai remained in a state of mild disorder for a long time. Approximately 70.97% of provinces had a coupling coordination degree interannual change rate below 3%, indicating strong path dependence. The coupling coordination degree in provinces coupling (autonomous regions) like Xizang and Gansu continued to deteriorate, intensifying the divergence trend between regions. Conclusion China's medical⁃economic system is generally in a state of low⁃level equilibrium with significant regional disparities. The coupling coordination degree is higher in the Eastern regions and poorer in the Western regions. Within the system, human resources and innovation⁃driven development carry the highest weights, but inter⁃regional divergence is intensifying, showing clear characteristics of path dependence. There is an urgent need to implement precise policy interventions to break the low⁃level equilibrium and promote the system's evolution towards a high level of coordination.

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