https://orcid.org/0009-0007-6070-2839
Figures
Abstract
Background
Traditional Chinese Medicine (TCM) is increasingly integrated into healthcare and insurance systems, therefore, it is essential to understand its current status and patients’ perspectives.
Methods
This cross-sectional study was conducted from January 1st to December 31st, 2023, across five TCM practices in Switzerland. All patients attending their sixth therapy session were invited to complete an electronically anonymized questionnaire covering patient demographics, treatment experiences, and satisfaction.
Results
A total of 461 patients participated in the survey, with the majority being female (60.1%) and aged 50 years or older (57.4%). Among them, 54.0% reported multiple health conditions, with 32.9% having musculoskeletal disorders and 31.8% suffering from chronic pain as the main reasons for seeking therapy. Most patients received weekly TCM treatments (91.3%), with 50.7% also undergoing conventional therapies. Of the respondents, 50.0% reported full coverage for their TCM therapy costs. Access to TCM was primarily through personal recommendations (44.5%), and 92.2% of patients reported waiting less than 10 minutes before each therapy session. Acupuncture was the predominant treatment (95.7%), with 35.8% receiving additional dietary advice. The overall patient satisfaction rate stood at 96.5%, with 99.5% indicating their intention to continue receiving TCM treatments. Notably, patients with full insurance coverage for TCM treatment costs demonstrated significantly higher treatment satisfaction compared to those with no coverage (odds ratio = 2.42, 95% confidence interval [1.10 to 5.31], p = 0.028). By contrast, other evaluated medical factors did not show statistically significant associations with treatment satisfaction.
Conclusion
This study revealed that women, patients aged over 50, and individuals with multiple health conditions, particularly musculoskeletal disorders and chronic pain, are more likely to seek regular integrated TCM treatment. Patients reported high levels of satisfaction with TCM, with treatment satisfaction significantly higher among those with full insurance coverage for TCM treatment costs compared to those without coverage. Future research should enroll a broader range of TCM practices and patient populations to enhance the generalizability of these findings and accurately evaluate how insurance coverage influences TCM satisfaction, thereby better addressing patient needs.
Citation: Liu Y, Lyu X, Pradhan SK, Li Y, Liu X, Bauder R, et al. (2025) Patient demographics, medical factors, treatment modalities and satisfaction at five traditional Chinese medicine practices in Switzerland: A cross-sectional study. PLoS One 20(9): e0332586. https://doi.org/10.1371/journal.pone.0332586
Editor: Jenny Wilkinson, Endeavour College of Natural Health, AUSTRALIA
Received: February 14, 2025; Accepted: August 29, 2025; Published: September 19, 2025
Copyright: © 2025 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: This project received no specific funding from public, commercial, or non-profit funding agencies.
Competing interests: The authors have declared that no competing interests exist.
Background
Traditional Chinese Medicine (TCM), a well-established system rooted in thousands of years of clinical practice and based on concepts such as yin-yang and qi, encompasses therapeutic modalities including acupuncture, cupping, herbal medicine, and life cultivation [1]. In Europe, TCM is classified under the broader category of Complementary and Alternative Medicine (CAM), which includes medical practices and products not typically part of conventional Western medicine [2]. The recognition of TCM in Europe has advanced notably, with TCM herbal drugs incorporated into the European Pharmacopoeia [3] and the inclusion of TCM diagnostic patterns in Chapter 26 of the International Classification of Diseases, 11th Revision (ICD-11) [4,5]. A literature search in 2012 estimated at least 305,000 registered CAM providers in the European Union, acupuncture (n = 96,380) was the most widely therapeutic method for both medical (80,000) and non-medical (16,380) practitioners [6]. Research indicates that the use of CAM in Switzerland shares certain similarities with that in other European and Western countries, allowing for meaningful comparisons. However, notable differences also exist and should be taken into account [7,8].Thus, investigating the situation of TCM in Switzerland has significant relevance [9].
Since 2012, in Switzerland, TCM has been covered by basic health insurance when provided by certified physicians, and by supplementary insurance when administered by accredited therapists [10]. As a result, the use of Complementary Medicine (CM)—a subset of CAM referring to non-mainstream approaches used alongside conventional treatments—increased significantly from 24.7% in 2012 to 28.9% in 2017 (p < 0.001) [11]. Moreover, cross-sectional surveys conducted among representative samples of Swiss adults showed a steady rise in TCM use, from 6.6% in 2007 (including acupuncture and other TCM therapies) to 8.5% in 2017, a statistically significant increase [9,11].
In 2008, Michlig et al. conducted a prospective study in which patients reported significantly higher satisfaction after a 4-week follow-up when receiving TCM treatment from conventional physicians with additional TCM certification compared to conventional medicine therapy alone. However, there was no significant difference in complete recovery or marked symptom improvement [12]. Nevertheless, this study did not identify the TCM-related factors influencing treatment satisfaction. Since most TCM providers are not Western Medicine physicians, further research is warranted.
Although there are many studies on CAM from various databases, research on the real-world application of TCM and patient perspectives remains limited [13,14]. Therefore, this cross-sectional study investigates patient characteristics, medical factors, treatment modalities, and satisfaction among individuals undergoing TCM treatment in five practices during the first year of implementing a satisfaction questionnaire.
Methods
Study design
This cross-sectional study was conducted between January 1 and December 31, 2023, across five TCM practices in Switzerland (practices located in Bad Zurzach, Baden, Lenzburg, Wil, Zug). All participating practices adhered to standardized treatment protocols and employed certified TCM providers, ensuring a consistent quality of care across sites. Among the ten TCM providers surveyed in this study, four held bachelor’s degrees, two held master’s degrees, and four held doctoral degrees in TCM. Two TCM providers were licensed medical doctors. Overall, their average duration of TCM clinical practice was 22.7 ± 11.4 years, ranging from 10 to 40 years.
In agreement with the Swiss Human Research Act (HRA) and due to the assessment of anonymized data, this survey did not require ethical approval. This was confirmed by the local Ethics Committee Northwest and Central Switzerland (Req-2022–01098). The study was conducted according to the guidelines of the Declaration of Helsinki. The completion and findings of the individually completed questionnaires were not available to the TCM practice staff during the assessment period.
Study population and eligibility
The survey was distributed to adult patients who had provided written informed consent, and to underage patients with consent provided by their parents or legal guardians. Eligible patients were German- or English-speaking patients who had completed six sessions of TCM treatment at one of the five participating practices, typically over a period of about three weeks. Patients were included in the survey regardless of whether they intended to continue or discontinue treatment beyond the sixth session. This timing was chosen to ensure that participants had received sufficient exposure to the treatment to provide a meaningful assessment. Patients who had attended fewer than six therapy sessions or lacked adequate reading or language proficiency were excluded.
Data collection and management
The survey was created using EvaSys software [15] and completed by patients on a tablet after completing their sixth treatment session. An example of the questionnaire is provided in the Supporting Information (S1 File). It collected a wide range of information, including demographics (e.g., sex and age), medical factors (e.g., treatment season, self-reported health conditions, treatment regularity, concurrent treatment with conventional medicine, and insurance status and coverage), TCM treatment modalities, and aspects of patient satisfaction.
The questionnaire was developed collaboratively by certified TCM providers and academic researchers, drawing on existing instruments and expert recommendations. It was reviewed by multiple external consultants with prior collaboration experience with the World Health Organization (WHO) Traditional, Complementary and Integrative Medicine (TCI) Unit. The original version was in English and was translated into German using forward and backward translation by two independent bilingual translators. Discrepancies were resolved through consensus. To ensure clarity and feasibility, a three-month pilot study was conducted in 2022, during which a total of 151 patients completed the survey. Based on the feedback from these patients, TCM providers, and the administration, the final questionnaire was developed. The survey was administered electronically with built-in validation features (e.g., required fields) to minimize data entry errors. Anonymous participation was employed to encourage honest responses and reduce social desirability bias.
As the study focused on descriptive analyses of observed patient characteristics and satisfaction patterns rather than measurement of latent constructs, formal psychometric validation (e.g., reliability or factor analysis) was not prioritized. Future research will consider systematic validation of the instrument’s measurement properties.
To maintain data quality and transparency, all statistical analyses were based on valid responses per item. Missing data were not imputed, consistent with the study’s aim to reflect real-world observational data rather than conduct complete-case analyses. Variation in response rates across items primarily resulted from the optional nature of certain questions and minor questionnaire adjustments during the study period.
Statistical analysis
The reporting of the findings of this study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [16]. The data are summarized as numbers and proportions. Missing data of questionnaire items were not imputed and data analysis was conducted in all patients submitting a questionnaire. Comparisons between proportions were conducted with χ² tests. Ordered logistic regression analysis examined the relationship between treatment satisfaction, patient demographics, and medical factors. A two-sided p < 0.05 was considered to reflect statistical significance. All statistical analyses were conducted with the software R, version 4.0.5 (R Foundation for Statistical Computing in Vienna, Austria).
Results
Study participation
Out of 1,095 patients who initiated a new TCM therapy in 2023, 473 received a sixth session, and 461 completed and returned anonymous satisfaction surveys, while 12 individuals declined to participate. Overall, 94.6% of all survey items were answered, resulting in missing data in 5.4%.
Patient and TCM practice characteristics
In the study, 277 (60.1%) were women, significantly more than men (p < 0.001). Patients aged ≥50 years outnumbered those aged <50 years (p = 0.002). The median age category was 50–60 years, and the average age of male patients was higher than that of female patients (Table 1, eFig 1). In terms of treatment regularity, patients receiving weekly treatments (91.3%) significantly outnumbered those receiving treatments irregularly (p < 0.001). Half of all respondents reported concurrent treatment with conventional medicine. There was a significant difference in insurance coverage for TCM treatment costs (p < 0.001); 50% reported that they could cover the TCM treatment expenses fully, 45% partially, and 5% not at all. There were statistically significant differences in patient enrollment across the four seasons, with winter showing the lowest proportion of patients (19.5%) (Table 1).
Panel A shows the proportion of overall therapeutic reasons; Panel B shows the proportion of therapeutic reasons under acute pain; Panel C shows the proportion of therapeutic reasons under chronic pain; Panel D shows the proportion of therapeutic reasons without pain.
Medical factors
The survey listed 23 possible self-reported health conditions for seeking TCM treatment. Each patient reported an average of 2.0 ± 1.5 different health conditions, ranging from 1 to 9. Patients with multiple conditions (54.0%) outnumbered those with a single condition (46.0%), although the difference was not statistically significant. Among all patients, the most reported reasons for seeking TCM treatment were musculoskeletal disorders (33%) and chronic pain conditions (32%) (Fig 1, Panel A). Both acute and chronic pain conditions were closely linked with musculoskeletal disorders (Fig 1, Panels B to D).
TCM treatment modalities
Patients were primarily introduced to TCM through personal recommendations (45%) and the Internet (23%). Most patients reported minimal average waiting times before each therapy session, with over 50% indicating no waiting time at all. The patients reported an average of 1.5 ± 0.4 different treatment therapies and 1.3 ± 0.1 different lifestyle modification recommendations. Acupuncture was the most used therapy in more than 95% of cases. Many patients received lifestyle advice, particularly on diet. Overall, 99.5% of patients were positive about continuing TCM treatment (Table 2).
Patient-reported satisfaction
Overall satisfaction of all respondents was 96.5% and similar across multiple domains, including treatment satisfaction, medical environment, administration, and TCM providers (Table 3, Fig 2). Treatment satisfaction was reported by 86.3% of respondents, with 52.3% indicating they were “very satisfied” and 34.0% “satisfied,” while 5.7% were dissatisfied and 8.0% unable to evaluate. Other domains, such as billing inquiry, medical consultation, disease explanation, and treatment instruction, received “very satisfied” ratings of 65.9%, 69.4%, 60.4%, and 60.7%, respectively (Table 3, Fig 2).
TCM, traditional Chinese medicine.
In univariate ordered logistic regression analyses, full insurance coverage for TCM treatment costs was positively associated with higher treatment satisfaction (Table 1). Other variables did not show relevant associations with treatment satisfaction (Table 1).
Discussion
Traditional Chinese Medicine (TCM) has gained increasing attention as a complementary approach to conventional healthcare, yet detailed insights into the characteristics of patients seeking TCM and their treatment experiences remain limited. In this cross-sectional study conducted in five Swiss TCM practices in 2023, we aimed to explore patient demographics, medical factors, treatment modalities and satisfaction. Our findings revealed that patients presenting for TCM therapy exhibit a broad spectrum of underlying health conditions and report high satisfaction after the sixth therapy session.
The demographic characteristics, including a higher proportion of women and older adults utilizing TCM, align with global patterns where women and elderly individuals tend to use complementary medicine more frequently(eFig 1), possibly related to their higher prevalence of chronic diseases [9,17–19]. TCM’s holistic approach, addressing both physical and emotional health aspects, potentially complements conventional medical treatments and meets patients’ diverse needs [20].
The most commonly treated health conditions, as self-reported by patients, were musculoskeletal disorders, pain, and gastrointestinal conditions, which are consistent with areas where TCM, especially acupuncture, has demonstrated evidence-based efficacy [21]. Clinical guidelines recommend non-drug interventions such as acupuncture and multidisciplinary rehabilitation for conditions like low back pain [22]. Furthermore, acupuncture has demonstrated positive outcomes in treating gastroesophageal reflux disease, ulcerative colitis, and Crohn’s disease [23–25]. These findings underscore TCM’s potential role within modern multidisciplinary healthcare, highlighting the need for further prospective clinical research and interdisciplinary collaboration to better define its effectiveness and applications [26].
No correlation was found between treatment satisfaction and factors such as patient age, sex, treatment season. Interestingly, the study also found that patients with full insurance reimbursement reported greater satisfaction than those with no coverage, reflecting the critical impact of economic accessibility on patient experience and treatment adherence [27]. Financial burdens may deter patients from continuing therapy despite perceived benefits, indicating that improving insurance coverage could enhance adherence and satisfaction, thereby potentially improving clinical outcomes.
Acupuncture was the predominant treatment modality used in this study, received by 95.7% of patients, consistent with national survey data and clinical practice norms [11,28]. Its well-documented efficacy in musculoskeletal pain explains its widespread use [21], while TCM’s integrative approach often combines multiple modalities to restore body balance, which may further contribute to perceived benefits.
Patient satisfaction is a complex, multidimensional outcome influenced by the medical environment, administrative processes, treatment efficacy, and communication [29]. Although patients generally valued the medical environment and administration, gaps were noted in the transparency of billing and insurance coverage information. Providing clear, upfront explanations of treatment costs and reimbursement policies may improve adherence and satisfaction, particularly among patients with limited insurance coverage. Moreover, dedicating sufficient time for consultations to explain diagnoses, treatment rationale, and instructions could enhance patient understanding and engagement. Variations in satisfaction across disease types warrant further exploration through prospective clinical trials to elucidate underlying factors.
This study has several limitations. First, the reliance on self-reported questionnaires may introduce reporting bias, as patients might provide higher satisfaction ratings due to social desirability. Second, surveying patients at the sixth treatment session helps ensure sufficient treatment exposure for meaningful satisfaction assessment, but may still introduce selection bias, as dissatisfied patients may have discontinued treatment earlier and were therefore not captured. Moreover, the survey likely missed acute illnesses, which are commonly treated with less than six therapy sessions. The lack of classification of patient health conditions according to the International Classification of Diseases (ICD-10), combined with the fact that health conditions were self-reported by patients, limits the precise assessment of disease status and relevant influencing factors. However, those health conditions represent real-world complaints of patients seeking a TCM therapy. Many of those patients and health conditions are not diagnosed or classified by ICD-10. Finally, as the study was conducted solely in five Swiss TCM practices, the external validity of findings should be confirmed through similar research in other cultural and healthcare contexts.
Future research should include prospective studies to validate the impact of insurance coverage on long-term adherence and integrate subjective satisfaction measures with objective health outcomes, such as pain scores and functional improvements, to comprehensively evaluate TCM treatment effectiveness.
Conclusion
This cross-sectional study conducted in five Swiss TCM practices showed that patients seeking TCM therapy present with diverse health conditions, primarily musculoskeletal disorders, and generally report high treatment satisfaction after six treatment sessions. Acupuncture combined with lifestyle recommendations was the main treatment approach. Those findings indicate that acupuncture could be considered when patient satisfaction for Western Medicine becomes questionable. The study found that insurance coverage significantly influences treatment satisfaction, highlighting the important role of economic accessibility in patient adherence and experience. This association between treatment satisfaction and financial coverage of TCM therapies implies that the overall situation remains challenging for patients.
Supporting information
S2 File. eFig 1: Age distribution in female and male returning a satisfaction questionnaire; STROBE Checklist for Reporting Cross-sectional Studies.
https://doi.org/10.1371/journal.pone.0332586.s002
(DOCX)
References
- 1. Chung VC, Ho FF, Lao L, Liu J, Lee MS, Chan KW, et al. Implementation science in traditional, complementary and integrative medicine: An overview of experiences from China and the United States. Phytomedicine. 2023;109:154591. pmid:36610171
- 2. Møller SR, Ekholm O, Christensen AI. Trends in the use of complementary and alternative medicine between 1987 and 2021 in Denmark. BMC Complement Med Ther. 2024;24(1):23. pmid:38184579
- 3. Knoess W, Wiesner J. The Globalization of Traditional Medicines: Perspectives Related to the European Union Regulatory Environment. Engineering. 2019;5(1):22–31.
- 4. Lam WC, Lyu A, Bian Z. ICD-11: Impact on Traditional Chinese Medicine and World Healthcare Systems. Pharmaceut Med. 2019;33(5):373–7. pmid:31933225
- 5.
International Classification of Diseases 11th Revision. [cited 10 Jan 2024]. Available from: https://icd.who.int/en
- 6. von Ammon K, Frei-Erb M, Cardini F, Daig U, Dragan S, Hegyi G, et al. Complementary and alternative medicine provision in Europe--first results approaching reality in an unclear field of practices. Forsch Komplementmed. 2012;19(Suppl 2):37–43. pmid:23883943
- 7. Grass F, Berna C, Vogel C-A, Demartines N, Agri F. Complementary and integrative medicine - Resolving situations of reduced remuneration for additional work under the SwissDRG system. Heliyon. 2024;10(15):e34732. pmid:39157326
- 8. Linde K, Bayer R, Gehrmann J, Jansky B. How does the role of complementary and alternative medicine in general practice differ between countries? Interviews with doctors who have worked both in Germany and elsewhere in Europe. BMC Complement Med Ther. 2024;24(1):328. pmid:39227930
- 9. Klein SD, Torchetti L, Frei-Erb M, Wolf U. Usage of Complementary Medicine in Switzerland: Results of the Swiss Health Survey 2012 and Development Since 2007. PLoS One. 2015;10(10):e0141985. pmid:26513370
- 10.
Médecine complémentaire: nouvelles règles de remboursement: Le conseil fédéral admin.ch. [cited 20 Jan 2024]. Available from: https://www.admin.ch/gov/fr/accueil/documentation/communiques.msg-id-67050.html
- 11. Meier-Girard D, Lüthi E, Rodondi P-Y, Wolf U. Prevalence, specific and non-specific determinants of complementary medicine use in Switzerland: Data from the 2017 Swiss Health Survey. PLoS One. 2022;17(9):e0274334. pmid:36103571
- 12. Michlig M, Ausfeld-Hafter B, Busato A. Patient satisfaction with primary care: a comparison between conventional care and traditional Chinese medicine. Complement Ther Med. 2008;16(6):350–8. pmid:19028336
- 13. Wang X, Lv X, Chen B, Pradhan S, Bauder R, Li Y, et al. The first general consent implementation in swiss traditional Chinese medicine practices. A prospective one-year study. medRxiv. 2024, p. 2024.08.18.24312166.
- 14. Chen B, Lyu X, Lottenbach K, Zeier C, Jaminet D, Solongo S, et al. Traditional Chinese medicine research activity in switzerland. A systematic review and bibliometric analysis. medRxiv. 2024, p. 2024.07.10.24310251.
- 15.
EvaSys Online Survey Platform. [cited 10 Dec 2022]. Available from: https://evasys.de/en/
- 16. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297. pmid:17941715
- 17. Vaidya V, Partha G, Karmakar M. Gender differences in utilization of preventive care services in the United States. J Womens Health (Larchmt). 2012;21(2):140–5. pmid:22081983
- 18. Redondo-Sendino A, Guallar-Castillón P, Banegas JR, Rodríguez-Artalejo F. Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health. 2006;6:155. pmid:16780576
- 19. Li C, Zhou R, Yao N, Cornwell T, Wang S. Health Care Utilization and Unmet Needs in Chinese Older Adults With Multimorbidity and Functional Impairment. J Am Med Dir Assoc. 2020;21(6):806–10. pmid:32222351
- 20. Wang W-J, Zhang T. Integration of traditional Chinese medicine and Western medicine in the era of precision medicine. J Integr Med. 2017;15(1):1–7. pmid:28088253
- 21. Allen J, Mak SS, Begashaw M, Larkin J, Miake-Lye I, Beroes-Severin J, et al. Use of Acupuncture for Adult Health Conditions, 2013 to 2021: A Systematic Review. JAMA Netw Open. 2022;5(11):e2243665. pmid:36416820
- 22. Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians, Denberg TD, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514–30. pmid:28192789
- 23. Zhang B, Hu Y, Shi X, Li W, Zeng X, Liu F, et al. Integrative Effects and Vagal Mechanisms of Transcutaneous Electrical Acustimulation on Gastroesophageal Motility in Patients With Gastroesophageal Reflux Disease. Am J Gastroenterol. 2021;116(7):1495–505. pmid:34183577
- 24. Song G, Fiocchi C, Achkar J-P. Acupuncture in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019;25(7):1129–39. pmid:30535303
- 25. Bao C, Wu L, Wang D, Chen L, Jin X, Shi Y, et al. Acupuncture improves the symptoms, intestinal microbiota, and inflammation of patients with mild to moderate Crohn’s disease: A randomized controlled trial. EClinicalMedicine. 2022;45:101300. pmid:35198926
- 26. Mallory MJ, Do A, Bublitz SE, Veleber SJ, Bauer BA, Bhagra A. Puncturing the myths of acupuncture. J Integr Med. 2016;14(5):311–4. pmid:27641603
- 27. Godoy JA, Pavan G, Monteiro RT, Motta LS, Pacheco MA, Nogueira EL, et al. Satisfaction with care in a Brazilian psychiatric inpatient unit: differences in perceptions among patients according to type of health insurance. Trends Psychiatry Psychother. 2019;41(1):27–35. pmid:30994784
- 28. Wen J, Chen X, Yang Y, Liu J, Li E, Liu J, et al. Acupuncture Medical Therapy and its Underlying Mechanisms: A Systematic Review. Am J Chin Med. 2021;49(1):1–23. pmid:33371816
- 29. Batbaatar E, Dorjdagva J, Luvsannyam A, Amenta P. Conceptualisation of patient satisfaction: a systematic narrative literature review. Perspect Public Health. 2015;135(5):243–50. pmid:26187638