Exploring the pathways of digital technology driven healthcare service delivery in county-level regions

Considering China's continuous promotion of the Healthy China strategy, the primary healthcare system in county areas is increasingly exposed to structural challenges such as uneven distribution of resources between urban and rural areas and inadequate service accessibility. Digital technologies provide new opportunities for restructuring healthcare service delivery in counties; however, the specific mechanisms driving this change and the conditions necessary for successful implementation are still not well understood. Using 30 digitally-empowered counties in China as case studies, we investigated the group effects and enhancement paths of technological, organizational, and environmental factors on healthcare service provision in primary counties based on the TOE theoretical analytical framework using fuzzy-set Qualitative Comparative Analysis (fsQCA) methodology. The study shows that, firstly, technology, organization and environment are insufficient to constitute the necessary conditions for providing medical services in the county. Second, the "multiple concurrency" of technology, organization and environment constitutes four driving paths of digital empowerment for county healthcare service provision, including "technology-balanced" path, "technology-organization" path, "organization-environment" path and "all-round" path. Third, each county should adopt diversified supply paths according to its resource endowment and various advantages in the process of medical service supply. This research systematically identifies various pathways for digital empowerment in county-level healthcare. It offers both a theoretical framework and practical insights based on a configuration perspective enhancing our understanding of the digital transformation of primary healthcare systems.