Objective: To explore the paths between construction strategies and performance of county medical consortia and in- forming policy making for further high-quality development of county medical consortia. Methods: It analyzes current development status of county medical consortia in Guangdong Province, and explored the core conditions and configuration paths between construc- tion strategies and performance of county medical consortia using fuzzy-set Qualitative Comparative Analysis (fsQCA). Results: There are three effective paths for achieving high performance of county medical consortia. The core conditions are the effective evaluation of county medical consortia, unified management of finance and drug. Though information sharing is not implemented well, high perfor- mance can be achieved with the above core conditions implemented effectively. There are 11 effective paths for non-high performance of county medical consortia. The core conditions for non-high performance include the ineffective implementation of decision-making autonomy, unified management of finance and income. Conclusion: The key to improving the performance of county medical consortia is effective implement of decision-making autonomy, evaluation, and the unified management of finance, drugs and income in county medical consortia.