Towards Differentiated Governance: A Typology and Differentiated Governance Framework for County-Level Traditional Chinese Medicine Hospitals in China

Abstract This study addresses the heterogeneity in development potential among public county-level Traditional Chinese Medicine (TCM) hospitals in Zhejiang Province, China. Employing a sequential mixed-methods design, we conducted cluster analysis on data from 78 counties and supplemented this with 24 stakeholder interviews. Four distinct archetypes were identified: Leading Development Zones, Pressure & Challenge Zones, Steady Improvement Zones, and Foundation Building Zones. Development potential emerges from the interaction between external resource dependencies and internal adaptability. We propose a differentiated “diagnose-classify-prescribe” governance framework, advocating for tailored roles—such as “innovation catalyst” or “system stabilizer”—to move beyond uniform policies. This model offers actionable, context-sensitive strategies for integrating traditional medicine into diverse health systems locally and globally.