Abstract: Starting from a comparative research perspective, this article analyzes and sorts out the typical models of the reform of three traditional Chinese medicine medical insurance payment methods in China, providing a basis and reference for optimizing the payment methods of traditional Chinese medicine medical insurance in the future. Nanjing City is implementing DRG (Diagnosis Related Groups) traditional Chinese medicine grouping, Liuzhou City is implementing payment based on the therapeutic value of advantageous diseases in traditional Chinese medicine, and Hangzhou City is implementing a payment tilt policy for traditional Chinese medicine medical services based on the "treatment rate". The three regions have tried different approaches and formed different reform models for traditional Chinese medicine medical insurance payments, playing a pioneering and exemplary role in promoting the development of traditional Chinese medicine. Through comparison, it can be concluded that the reform of traditional Chinese medicine medical insurance payment methods needs to grasp the essence of the advantages of traditional Chinese medicine, and introduce payment methods that reflect traditional Chinese medicine elements and combine multiple paths based on local conditions, in order to promote the development of traditional Chinese medicine and the high-quality development of traditional Chinese medicine hospitals.