Objective:To analyze the structural changes in medical revenue of public hospitals in China from 2012 to 2023, for references for refining healthcare reform policies and hospital performance management.Methods:Based on panel data from the China Health Statistical Yearbook, we analyzed the structural changes in medical revenue of public hospitals at different levels from 2012 to 2023; the growth multiple of regional medical revenue (the ratio of medical service revenue in 2023 to that in 2012); as well as the changes in the value of structure variation, the degree of structure variation, and the contribution rate of structure variation for each medical revenue (including revenue from medical services, pharmaceuticals, diagnostic tests, and medical supplies). Results:From 2012 to 2023, the structure of medical revenue in China′s public hospitals exhibited a sustained optimization trend. The proportion of pharmaceutical revenue declined from 44.80% to 27.92%, with the contribution rate of structure variation of 59.50%, reflecting the primary driver behind the optimization of the revenue structure. Medical service revenue increased from 21.60% to 24.92%, while examination and medical material revenue rose from 11.55% and 8.58% to 14.66% and 14.51%, respectively. Following the complete elimination of drug markups in 2017, the growth rate of revenue from medical services at hospitals of all levels had increased significantly. The growth multiples for medical service revenue varied significantly by region, with the western region recording the highest multiple (3.37)and the northeastern region the lowest (2.58). The results of the structural change analysis showed significant differences among public hospitals of different levels. In terms of the contribution rate of structure variation of drug revenue, tertiary hospitals had the highest rate at 59.71%, followed by primary hospitals (42.64%), with secondary hospitals having the lowest rate (22.98%); Regarding the medical service revenue, secondary hospitals (39.47%) were close to primary hospitals (39.42%), and both were significantly higher than that of tertiary hospitals (13.76%).Conclusions:The medical revenue structure of public hospitals in China continued to improve, existing disparities among hospitals at different levels. The reform to eliminate markups on drugs had yielded significant results, but the percentages of revenue from examination and medical material continued to rise, and the revenue compensation mechanism for medical services needed further refinement. It was recommended to establish a dynamic adjustment mechanism for medical service pricing, strengthen tiered and categorized performance evaluations, deepen the reform of " three-medical linkage", as well as increase policy support for less developed regions.