By using the coupling coordination model, exploratory spatial data analysis method and geographical detector model, this paper analyzes the synergy between basic medical security and regional economy in China and its spatial differentiation factors, so as to provide reference for promoting the coordinated development of basic medical security and regional economy. The results show that from 2018 to 2021, the coupling and coordination degree between China's basic medical security and regional economic development shows an increasing trend, but the level is still low, and the regional differences are significant, showing a spatial distribution pattern of "high in the east and low in the west" as a whole; Regional GDP, basic medical insurance fund expenditure, general budget revenue, population, income decentralization and medical assistance expenditure are the main driving factors that affect the spatial differentiation of the coordinated development of the two systems. In this regard, we should give play to the supporting role of government policies and promote the high-quality development of regional economy through industrial policies, fiscal policies and monetary policies; Deepen the construction of basic medical security system and promote the continuous improvement of social livelihood; By strengthening the overall planning and making precise policies for different regions, the coordinated development of basic medical security and regional economy will be promoted.