This paper used the coupling coordination degree model，exploratory spatial data analysis method and geographical detector model to analyze the synergy between basic medical insurance and regional economy in China and its spatial differentiation factors. The results show that，the coupling and coordination degree between China’s basic medical security and regional economic development exhibits an increasing trend from 2018 to 2021，but still at a low level，with significant regional differences，overall showing a spatial distribution pattern of high in the east and low in the west. Regional GDP，basic medical insurance fund expenditure， general budget revenue， population size， income decentralization， and medical assistance expenditure were the main driving factors affecting the spatial differentiation of coordinated development of the two systems. Based on this，corresponding countermeasures and suggestions are put forward to provide reference for promoting the coordinated development of basic medical security and regional economy.