The study aims to assess the impact of the "zero-waste city" pilot policy on medical waste generation by employing the synthetic control method based on dynamic panel data from 35 large and medium-sized Chinese cities between 2013 and 2022. The study uses Beijing, Tianjin, Shenzhen, and Chongqing, four cities selected in the first batch of the zero-waste city pilot program released by the Ministry of Ecology and Environment in 2019, as the treatment group, with the remaining cities serving as the control group. Results indicate that among the four pilot cities, only Beijing achieved a statistically significant reduction in per capita medical waste generation, averaging 9.22 tons less per 10 000 people annually compared to its synthetic control group, representing an 18.7% decrease. This outcome may be attributed to dedicated financial support, the establishment of a closed-loop, full-process supervision system, and extensive social mobilization. These findings suggest that other cities can draw valuable lessons from Beijing's experience to advance their own zero-waste city initiatives.