Technology is the heartbeat of contemporary healthcare. From sophisticated medical imaging systems to real-time patient monitors and high-precision surgical robots, the acquisition of medical equipment is an essential function for any hospital or health system. However, the increasing complexity, specialization, and high cost of these technologies make the decision on how to acquire them more critical than ever.
It’s no longer just about buying a device; effective acquisition involves a holistic view that encompasses clinical needs, integration with other systems, technical maintenance, staff training, consumable management, and even the equipment’s final disposal. Choosing the wrong purchasing model can have negative repercussions on patient care quality, operational efficiency, and the organization’s financial sustainability.
What options are available?
Globally, various strategies have been developed for the acquisition of medical equipment. In addition to traditional models, innovative approaches are emerging, such as value-based purchasing, group purchasing organizations, direct purchase agreements, and consignment inventory models. Cost-effectiveness, regulatory compliance, and the pursuit of better patient outcomes are important driving forces in the evolution of these models.
Below, we explore six common models, analyzing in depth their advantages, disadvantages, and the allocation of risks between the State and private entities:
1. Public Tender (Equipment Only)
- What is it? A formal and competitive process where suppliers are invited to submit bids for the supply of specific equipment, based on the principles of transparency, fairness, and competition.
- Advantages:
- Promotes competition, which can lead to lower prices and cost-effectiveness.
- The structured process promotes transparency and accountability.
- Disadvantages and Risks:
- An excessive focus on the lowest price can compromise patient safety and quality.
- The process can be susceptible to corruption if not managed rigorously.
- Evaluating the real value beyond the price can be complex.
- Proposal preparation costs can be high for private entities, especially smaller ones.
- High competition does not guarantee contract award.
2. Public Tender (Equipment + Maintenance Services)
- What is it? Similar to the previous one, but the tender includes both the equipment and associated maintenance services (preventive and corrective) in a single package.
- Advantages:
- Simplifies acquisition by reducing the number of contracts.
- Allows for better forecasting of the total cost of ownership throughout the equipment’s lifecycle.
- Ensures maintenance is included from the outset, improving performance and reducing downtime.
- Disadvantages and Risks:
- Evaluating combined offers is more complex.
- There is a risk of being «tied» to a supplier for maintenance, limiting future flexibility.
- Possibility of maintenance costs being inflated to compensate for lower equipment prices.
- Smaller companies without established maintenance capabilities may be excluded from the tender.
- Proposal preparation is more complex and expensive.
3. Leasing or Renting
- What is it? Instead of buying, payment is made for the use of the equipment. Leasing is usually long-term with a purchase option, while renting is often shorter. Maintenance is usually included.
- Advantages:
- Lower initial cost, preserving capital for other needs.
- Facilitates access to cutting-edge technology and more frequent updates.
- Predictable payments simplify financial planning.
- The burden of maintenance often falls on the leasing company.
- Offers flexibility and scalability.
- Disadvantages and Risks:
- The total long-term cost may be higher than direct purchase.
- No asset ownership is generated (unless the purchase option is exercised).
- Less flexibility to modify equipment and potential penalties for early termination.
- The management of returns and updates can be logistically complex.
- Disputes over the use and condition of the equipment may arise.
4. Purchase through an Integrator (Preventive and Corrective Maintenance)
- What is it? A company (integrator) is hired to manage the acquisition, installation, and maintenance (preventive and corrective) of multiple equipment, acting as a single point of contact.
- Advantages:
- Greatly simplifies management, reducing the need to deal with multiple suppliers.
- Can improve integration and interoperability between different systems.
- Single point of contact for support and maintenance.
- Potential for customized solutions.
- Disadvantages and Risks:
- Potential for higher overall costs.
- Risk of integrator dependence («vendor lock-in»).
- The integration of complex systems can introduce technical challenges and cybersecurity vulnerabilities.
- Concerns about data accuracy and patient safety.
- High initial investment and experience are required for integrators.
5. Purchase through an Integrator (Preventive, Corrective Maintenance, and Spare Parts)
- What is it? Similar to the previous model, but the integrator is also responsible for managing and supplying the necessary spare parts.
- Advantages:
- All the advantages of Model 4, plus a minimization of downtime thanks to the managed availability of spare parts.
- Greater predictability of maintenance expenses.
- Reduces the administrative burden of managing spare parts inventory.
- Disadvantages and Risks:
- All the disadvantages and risks of Model 4, plus the potential risk of inflated costs for spare parts.
- Requires the integrator to effectively manage the inventory.
- Spare parts management adds complexity and financial risks.
6. Integrator Model Based on Clinical Requirements
- What is it? A more advanced approach where the hospital defines its clinical needs and desired outcomes, and the integrator is responsible for providing the combination of equipment and services to achieve those goals. It focuses on value and outcomes, not just equipment.
- Advantages:
- Directly aligns acquisition with patient needs and health outcomes.
- Incentivizes innovative and effective solutions from the integrator.
- Simplifies supplier management.
- Potential for sharing risks and rewards according to clinical success.
- Disadvantages and Risks:
- Defining and measuring clinical outcomes clearly is a challenge.
- Evaluating outcome-based offers is complex and can be subjective.
- High dependence on the integrator.
- Requires robust data collection and analysis systems.
Risk matrix
| Purchase Model | Risks to the State | Risks for the Private Sector |
| Model 1: Public Tender for Medical Equipment | * Possible selection of lower-quality products due to a focus on the lowest price. * Susceptibility to corruption.* Potential shortages if you rely on a single supplier. * Complexity in assessing true value beyond price. | * High proposal preparation costs. * Intense competition with no guarantee of winning the contract. * Possible unsustainable price wars. |
| Model 2: Public Tender for Medical Equipment and Maintenance Services | * Complexity in evaluating combined offers.* Possible link to a supplier.* Potential inflation of maintenance costs. | * Possible exclusion of smaller companies without maintenance capabilities.* Greater complexity and cost in preparing proposals. * Risk of providing maintenance services effectively and efficiently. |
| Model 3: Acquisition of Medical Equipment through Leasing or Renting | * Higher long-term costs than outright purchase.* No equipment ownership.* Less flexibility with modifications and repairs. * Possible penalties for early termination. * Operational risks if agreements are not renewed or extended. | * Risk of equipment obsolescence. * Logistical complexity in managing returns and upgrades. * Possible disputes over equipment use and condition. |
| Model 4: Purchase of Medical Equipment through an Integrator (Preventive and Corrective Maintenance) | * Potential for higher overall costs. * Possible vendor lock-in.* Complexity in defining requirements. * Integration, cybersecurity, and data accuracy risks. | * High initial investment and experience required .* Need to effectively manage relationships with various equipment manufacturers. * Possible responsibility for the overall performance and interoperability of the integrated system. |
| Model 5: Purchase of Medical Equipment through an Integrator (Preventive and Corrective Maintenance and Spare Parts) | * All risks of Model 4. * Potential for inflated spare parts costs . * Need for the integrator to effectively manage spare parts inventory. | * All risks of Model 4. * Added complexity of spare parts management.* Financial risk of maintaining spare parts inventory. |
| Model 6: Clinical Requirements-Based Integrator Model | * Challenge in clearly defining requirements and measurable clinical outcomes. * Increased complexity and subjectivity in evaluating outcomes-focused offerings. * Significant dependence on a single integrator. * Need for robust data collection and analysis systems to track and verify clinical outcomes . * Potential conflict of interest. | * Uncertainty in achieving clinical outcomes. * Possible financial penalties for not achieving agreed outcomes. * Significant investment in data collection and analysis is required. |
Summary of the main features of each model
| Feature | Model 1: Public Tender (Equipment) | Model 2: Public Tender (Equipment + Maintenance ) | Model 3: Leasing / Renting | Model 4: Integrator (Preventive and Corrective Maintenance) | Model 5: Integrator (Preventive, Corrective Maintenance and Spare Parts) | Model 6: Integrator (Clinical Requirements) |
| Responsible for the initial investment | State | State | Private entity (leasing / renting) | State | State | State |
| Maintenance Manager | State | Private entity (provider) | Often included in the agreement | Integrator | Integrator | Integrator |
| Technological update | Condition (new purchase) | Condition (new purchase) | Private entity (through new contracts) | Status (new purchase or through integrator) | Status (new purchase or through integrator) | Status (new purchase or through integrator) |
| Financial risk | Risk of cost overruns, state budget | Risk of cost overruns, state budget, maintenance costs | State: higher long-term costs. Private entity: obsolescence, returns management | Potential for higher costs for the State | Potential for higher costs for the State, spare parts inventory management | State: definition of requirements and payment for results. Private entity: achievement of clinical results. |
| Risk of obsolescence | State | State | Private entity (leasing / renting) | State | State | State |
| Main advantage | Cost efficiency, transparency | Process simplification, cost predictability | Financial flexibility, access to technology | Simplifying procurement, improving interoperability | Simplifying procurement, improving interoperability, and managing spare parts | Alignment with clinical needs, focus on results |
| Risk or disadvantage of the model | Possible low-quality selection, risk of corruption | Complexity in evaluation, possible dependence on the supplier | Higher long-term costs, no equipment ownership | Potential for higher costs, vendor lock-in, integration complexity | Potential for higher costs, supplier lock-in, integration complexity, spare parts management | Complexity in defining requirements, evaluating results, dependence on the supplier |
What Should We Consider When Choosing?
There is no one-size-fits-all solution. The choice of the most appropriate acquisition model will depend on a number of factors, including:
- The type of equipment to be acquired.
- The institution’s budgetary constraints.
- The pace of technological advances.
- The specific needs of the health system.
However, some key recommendations for making informed decisions are:
- Define clear objectives: Do you prioritize initial cost, access to cutting-edge technology, ease of management, integration with other systems, or a combination of these factors?
- Assess needs in depth: Understand in detail the clinical, technical, and operational requirements before making a decision.
- Balance cost and quality: Do not sacrifice patient safety or quality of care for the lowest price.
- Think about the Total Cost of Ownership (TCO): Consider all expenses associated throughout the equipment’s lifecycle, including maintenance, repairs, consumables, upgrades, and final disposal, not just the initial purchase price.
- Involve users: Gather input from doctors, nurses, biomedical engineers, and other healthcare professionals to ensure that the equipment meets real needs and integrates effectively into workflows.
Conclusion
The acquisition of medical equipment is a complex strategic decision with long-term implications for healthcare institutions and the system as a whole. Understanding the different models available, with their respective advantages, disadvantages, and risk allocations between the State and private entities, is a fundamental step towards making informed and responsible decisions. Each model offers a different balance between cost, control, flexibility, and risk. Carefully analyzing priorities and choosing the path that best aligns with the organization’s strategic and clinical objectives is essential to ensure quality and sustainable healthcare.
Descarga aquí documento completo en español