General practitioners are critical for realizing the safety-net function of the primary healthcare system; however, there are regional disparities in their resource allocation. Existing studies have mainly explained disparities in general practitioner (GP) resource allocation from single-factor or linear perspectives, with limited attention to the synergistic effects of multiple conditions and their underlying mechanisms.

To identify multiple pathways leading to stronger primary healthcare service capacity and to examine the associations between different configurations and the equity of GP resource allocation, as well as the mediating mechanism of primary healthcare service capacity.

Panel data of 31 provincial-level administrative regions in China from 2011 to 2024 were selected. Data were obtained from health and population statistical yearbooks and official public sources. Missing values were supplemented by linear interpolation, and variables were pre-processed via standardization, logarithmic transformation and other approaches. Taking the equity of general practitioner resource allocation as the explained variable, economic-social-policy conditions as antecedent conditions, and primary healthcare service capacity as the mediating variable, relevant control variables were also set. Fuzzy-set qualitative comparative analysis (fsQCA) was adopted to identify multiple configurations for achieving high-level primary healthcare service capacity. The configurational membership scores were quantified and incorporated into regression models to hierarchically test the direct effects of configurations on the equity of general practitioner resource allocation and the mediating transmission effect of primary healthcare service capacity.

Four equivalent pathways to high primary healthcare service capacity were identified: an economic-fiscal-social demand synergy-driven pathway, an economic-urbanization-population aging synergy pathway, a demand-policy support strengthening pathway, and an economic-urbanization-primary care supply synergy pathway. The overall consistency and coverage were 0.865 and 0.723, respectively. The economic-urbanization-primary care supply synergy pathway was significantly and positively associated with the equity of GP resource allocation (P<0.05). After primary healthcare service capacity was included in the regression models, it remained significantly and positively associated with GP resource allocation equity across all models (P<0.05). The direct associations of different configurations showed marked heterogeneity: the demand-policy support strengthening pathway had a significant positive association (P<0.05), whereas the economic-urbanization-primary care supply synergy pathway had a significant negative association (P<0.05).

The equity of GP resource allocation exhibits clear configurational heterogeneity, and primary healthcare service capacity may serve as an important pathway through which combinations of macro-level conditions affect equity. Differentiated resource allocation strategies should therefore be developed according to regional development conditions and population needs, while greater emphasis should be placed on strengthening primary healthcare service capacity.

全科医生是基层医疗卫生体系网底功能发挥的关键，但其资源配置存在区域差异。现有研究多从单因素或线性关系解释全科医生资源配置差异，对多重条件协同及其作用机制关注不足。

识别基层医疗服务能力的多元形成路径，考察不同组态与全科医生资源配置公平性的关系及其传导机制。

选取2011—2024年我国31个省级行政区面板数据，数据来源于各类卫生、人口统计年鉴及官方公开资料，缺失数据采用线性插值补齐，对变量做标准化、对数化等预处理。以全科医生资源配置公平性为被解释变量，经济-社会-政策条件为前因条件，基层医疗服务能力为中介变量，并设置相关控制变量。采用模糊集定性比较分析（fsQCA）识别形成高水平基层医疗服务能力的多元组态，将组态隶属度量化后引入回归模型，分层检验组态对全科医生资源配置公平性的直接效应，以及基层医疗服务能力的中介传导效应。

高水平基层医疗服务能力形成经济-财政-社会需求协同驱动型、经济-城镇化-老龄化协同型、需求-政策保障强化型、经济-城镇化-基层供给协同型4条等效路径，整体一致性和覆盖度分别为0.865和0.723。经济-城镇化-基层供给协同型与全科医生资源配置公平性呈显著正向关系（P<0.05）。纳入基层医疗服务能力后，该变量在各模型中均显著为正（P<0.05），且不同组态的直接关联呈现明显异质性，其中需求-政策保障强化型显著为正（P<0.05），经济-城镇化-基层供给协同型显著为负（P<0.05）。

全科医生资源配置公平性具有明显的组态异质性，基层医疗服务能力可能是宏观条件组合影响公平性的重要传导环节。应根据地区发展基础和人口需求实施差异化配置，并强化基层医疗服务能力建设。