Analysis of Non-Compliant Charging Risks in Cardiology Departments: Insights into Cardiovascular Patients' Healthcare-Seeking Behaviors and Governance Strategies from the Perspective of Behavioral Medicine

Abstract Background The standardization of medical expenses is crucial for protecting patients' rights and promoting the healthy development of the medical industry. Although China's medical insurance coverage has expanded, illegal charging in medical institutions has become more complex and covert. These behaviors increase patients' economic burden, distort resource allocation, damage doctor-patient trust, and cause psychological problems such as treatment-related anxiety—particularly salient among cardiovascular patients who often require long-term, continuous care. Purpose Non-compliant charging undermines medical fairness and transparency, affects patients' decision-making and treatment compliance, and may exacerbate anxiety and distrust in cardiology practice, where treatment adherence is critical to outcomes. Existing research lacks analysis of departmental heterogeneity within specialties such as cardiology, and sufficient quantitative research, thus failing to meet the requirements of refined supervision in heart care settings. Subjects and Methods Taking sub-specialties within a cardiology department of a tertiary hospital as subjects—covering areas such as interventional cardiology, electrophysiology, heart failure, and hypertension—a four-stage research model was applied to construct an analytical framework covering 8 core dimensions. Through systematic cluster analysis, ANOVA, and Pearson's chi-square test, high-risk sub-specialties and clustering patterns of non-compliant charging behaviors were identified, and a three-dimensional analytical model was established specifically for cardiology practice. Results The research findings revealed distinct risk patterns within cardiology sub-specialties. Common risks included illegal pricing of diagnostic and therapeutic items, especially in interventional and imaging-related procedures. Sub-specialties such as interventional cardiology showed synergistic risks of illegal use of medical insurance funds involving pharmaceuticals and high-value consumables (e.g., stents, catheters). Furthermore, comprehensive illegal risks related to medical consumables were prominent in interventional and electrophysiology divisions. From a behavioral medicine perspective, these non-compliant behaviors correlated with specific anxiety manifestations in cardiovascular patients: for instance, opaque charging in interventional cardiology could provoke acute procedural anxiety, while irregular drug pricing in chronic care sub-specialties increased long-term treatment anxiety in patients with conditions like heart failure or coronary artery disease. Conclusion Illegal charging behaviors in cardiology departments demonstrate “commonality and heterogeneity,” are closely related to departmental core businesses such as interventional procedures and chronic disease management, and are influenced by factors including insufficient system integration and weak information-based supervision. These behaviors exacerbate anxiety and distrust among cardiovascular patients, making supervision optimization urgent. A “common control and precise governance” differentiated supervision framework should be constructed for cardiology. Based on unified standards, supervision resources should be allocated according to sub-specialty risk characteristics, a full-process governance system should be established for high-risk areas, information-based verification and compliance training should be strengthened, and medical insurance policies should be better coordinated with cardiology clinical practice. Meanwhile, behavioral medicine interventions should be integrated—such as enhancing charge transparency, optimizing doctor-patient communication, and providing anxiety-alleviating education—to improve cardiovascular patients’ treatment compliance and healthcare experience while enhancing medical expense compliance management.