Towards differentiated governance: A typology and differentiated governance framework for county-level traditional Chinese medicine hospitals in China

Abstract

Public county-level Traditional Chinese Medicine (TCM) hospitals are critical for integrating traditional and modern medicine, yet their heterogeneous development potential hinders policy implementation. Using Zhejiang Province as a case and an integrated Resource Dependence-Complex Systems framework, this study employed a mixed-methods design—cluster analysis of 78 county-level units and in-depth interviews with 24 key stakeholders—to identify four developmental archetypes. Findings reveal that hospital potential is an ‘emergent property’ stemming from the interplay between external resource dependence and internal institutional adaptation. We propose a ‘diagnose-classify-prescribe’ differentiated governance framework, which tailors roles such as ‘innovation catalyst’ or ‘system stabiliser’ to specific contexts. This approach offers a transferable pathway for moving beyond one-size-fits-all policies and contributes to integrating traditional medicine into diverse local health systems globally.