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

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.