This study uses panel data from 30 provincial-level administrative divisions in China from 2014 to 2024 to construct a comprehensive evaluation index system for the digital economy and multi-level medical security. Employing the entropy weight method, the coupling coordination degree model, kernel density estimation, the obstacle degree model, and the optimal parameter geographic detector, the study systematically examines the spatio-temporal evolution, obstacle factors, and driving mechanisms of the coupling coordination between the two systems. The results show that the development levels of both the digital economy and multi-level healthcare security continue to improve, with their coupling coordination degree shifting from imbalance to coordination, showing a spatial pattern characterized by higher in the east, lower in the west, and higher in coastal areas, lower in inland areas. Second, the main obstacles are concentrated in digital industrial development, the basic medical security level, software business development, and medical assistance coverage. Third, information development and residents' consumption capacity are important driving factors, and interactions among factors generally exhibit a two-factor augmentation effect. Overall, although the coordinated development of the digital economy and multi-level healthcare security has made notable progress, it remains in a transitional stage from low-level coordination toward high-quality synergy. Future efforts should focus on implementing differentiated and systematic strategies tailored to regional disparities and structural weaknesses.