The long-standing dilemma of difficulties in the improvement of primary care in China has led to county-level medical alliances reforms in various regions throughout the country.

To analyze the combination of pathways that contribute to improving the service capabilities of county-level medical alliances, providing a reference for the improvement and promotion of county-level medical alliances.

CNKI and Wanfang Data Knowledge Service Platform were searched by using "county-level medical alliance" "county health care unit" as keywords from 2020-01-01 to 2022-11-26 to obtain 662 related papers, a total of 9 papers and 11 cases were selected in the analysis. Based on literature review and policy analysis, variables including scale of planning and implementation, close organizational structure, collaborative management system, information platform integration, regional resources sharing, medical insurance payment reform, and incentive mechanism design were identified as outcome variables, while the fuzzy set qualitative comparative analysis was used to identify multiple realization pathways for the service capability improvement of county-level medical alliances.

Four combinations of pathways were found to improve the service capability of county-level medical alliances. Pathway S1: planning and implementation scale * close organizational structure * collaborative management system * regional resources sharing * medical insurance payment reform * incentive mechanism design. Pathway S2: close organizational structure * collaborative management system * information platform integration * regional resources sharing * medical insurance payment reform * incentive mechanism design. Pathway S3: smaller scale of planning and implementation * close organizational structure * collaborative management system * non-integrated information platform * non-sharing of regional resources * medical insurance payment reform * incentive mechanism design. Pathway S4: smaller scale of planning and implementation * close organizational structure * collaborative management system * non-integrated information platform * regional resource sharing * medical insurance payment reform * no incentive mechanism design.

The improvement of service capability of county-level medical alliances needs to focus on close organizational structure, establish management system focusing on the collaboration of departments and member institutions, and promote medical insurance payment reform such as total budget management system of medical insurance funds and diagnosis related groups (DRGs) .

中国基层医疗服务长期面临着能力难以提升的困境，为此全国多地开展了县域医共体改革。

分析有助于提升县域医共体服务能力的路径组合，为完善和推进县域医共体建设提供参考。

于2020-01-01至2022-11-26，以"县域医共体""县域医疗服务共同体"为关键词检索中国知网和万方数据知识服务平台获得662篇相关文献，最终共筛选出9篇文献、11个案例。基于文献和政策分析确定规划实施规模、组织架构紧密、管理制度协作、信息平台整合、区域资源共享、医保支付改革、激励机制设计为条件变量，县域医共体服务能力提升（门急诊人次年均增长率）为结果变量，采用模糊集定性比较分析方法识别县域医共体服务能力提升的多元实现路径。

共有4条路径组合能提升县域医共体服务能力：路径S1，规划实施规模*组织架构紧密*管理制度协作*区域资源共享*医保支付改革*激励机制设计；路径S2，组织架构紧密*管理制度协作*信息平台整合*区域资源共享*医保支付改革*激励机制设计；路径S3，规划实施规模较小*组织架构紧密*管理制度协作*信息平台不整合*区域资源不共享*医保支付改革*激励机制设计；路径S4，规划实施规模较小*组织架构紧密*管理制度协作*信息平台不整合*区域资源共享*医保支付改革*不设计激励机制。

县域医共体服务能力提升需要重点构建紧密的组织架构，建立注重部门间协同性与成员单位间协作性的管理制度，推进诸如医保基金总额预算管理制和按病种付费（DRGs）的医保支付改革。