Clinical application and institutional governance of foods for special medical purposes in medical institutions of eastern coastal China: a cross-sectional study

Introduction Despite the established clinical value of Foods for Special Medical Purposes (FSMP) in improving patient outcomes, their integration into the Chinese healthcare system remains highly uneven. Using the economically developed Jiangsu Province as a representative model, this study aims to systematically evaluate the current status of FSMP clinical application and management, identify key systemic barriers, and provide empirical evidence to facilitate standardized management and policy optimization at both regional and national levels. Methods A cross-sectional survey was conducted in October 2025. A stratified sampling strategy was employed to invite 115 medical institutions across Jiangsu Province. A total of 94 valid questionnaires were recovered, yielding an effective response rate of 81.7%. The structured questionnaire collected multidimensional data, including hospital characteristics, FSMP accessibility, internal management protocols, clinical usage, monitoring systems, insurance reimbursement, and staff cognition. Data were analyzed using descriptive statistics and Chi-square tests. Results While the overall penetration rate of FSMP in surveyed hospitals was high (78.7%), standardization in management lagged significantly. Only 43.6% of hospitals had established an FSMP Management Committee. Although the variety of FSMP products available (median: 4) was comparable to that of “drug-coded” enteral nutrition preparations (median: 5), internal circulation pathways were fragmented, involving multiple departments such as nutrition and logistics. Payment barriers were prominent: only 2.1% of hospitals reported FSMP coverage by medical insurance, while 29.8% categorized costs as “meal fees.” Medical staff exhibited a dichotomy in cognition, characterized by high “product recognition” (e.g., 82.1% acknowledged taste advantages) but “insufficient clinical confidence” (e.g., 89.4% expressed concern over lack of reimbursement). Subgroup analysis revealed significant heterogeneity: economically developed regions (Southern Jiangsu) and tertiary public hospitals demonstrated significantly superior management and cognition levels ( p < 0.05). Conclusion The core issue is that the under-institutionalized and poorly regulated nature of FSMP is incompatible with China’s highly structured and protocol-driven medical management system. The sector is currently at a critical transition from “product accessibility” to “standardized management.” Future reforms must shift from “fragmented management” to “systematic governance” by clarifying the medical attributes of FSMP, establishing independent payment pathways, and strengthening information systems to overcome current impediments.