The Director of the Medical Equipment Department at North Khorasan University of Medical Sciences has highlighted the need to review decision-making mechanisms for medical equipment procurement. The following is his opinion.
Decisions about purchasing medical equipment in public hospitals go far beyond selecting a particular device or brand. They directly affect the quality of healthcare services, patient safety, the efficient use of public resources, and the long-term costs of the healthcare system.
Given that capital medical equipment requires substantial financial investment, one of the key challenges in some procurement processes is how different professional disciplines participate in and influence the final decision. In certain cases, the selection of a device brand or model may be influenced more by the opinion of an individual or a particular specialty than by a comprehensive technical, economic, and clinical assessment.
This does not mean that the opinions of physicians or other clinical users are any less important. Rather, it highlights the need for a decision-making framework that reflects the multidisciplinary nature of medical equipment procurement by bringing clinical perspectives together with engineering assessments, technical requirements, lifecycle costs, and management considerations.
Medical Equipment Procurement: A Multidimensional Decision with Long-Term Consequences
Medical equipment selection should not be based solely on purchase price or brand reputation. Installation and commissioning costs, spare-parts availability, after-sales service, repair and maintenance capabilities, user training, compatibility with hospital infrastructure, upgrade potential, and the device’s effective service life are among the factors that must be assessed before a purchasing decision is made.
Physicians, as clinical users, identify diagnostic and therapeutic needs and define the required performance of a device. Medical equipment specialists, meanwhile, assess technical specifications, reliability, safety, after-sales support, and maintenance costs to determine the technical and economic feasibility of each option. Finance, procurement, and hospital management departments also play important roles in evaluating available budgets and ensuring compliance with purchasing regulations.
No single discipline can independently address every aspect of such a decision. The central issue is not whether one profession should take precedence over another, but how different areas of expertise can be integrated into a transparent and accountable process.
The Consequences of Unstructured Decision-Making
When equipment is selected without documented and comparative assessments, the purchased device may not adequately match the healthcare facility’s actual needs, infrastructure, or maintenance capabilities. Similarly, a lower initial purchase price may lead to higher long-term costs due to expensive repairs, difficulties in obtaining spare parts, prolonged equipment downtime, and reduced availability of healthcare services.
From a public-sector management perspective, such outcomes can undermine the efficient allocation of public resources. The success of a procurement process should not be measured solely by the completion of a transaction or the delivery of a device. It should also be evaluated in terms of how well the equipment meets clinical needs, supports sustainable operation, and delivers value for the resources invested.
The Proposed Solution: An Evidence-Based Decision-Making Framework
To address these challenges, medical equipment procurement processes should be redesigned around a multicriteria, evidence-based decision-making framework. Under this approach, clinical needs, technical specifications, safety, total cost of ownership, after-sales service, spare-parts availability, maintainability, and compatibility with existing infrastructure should be established as explicit evaluation criteria.
First, the clinical need and expected function of the device should be defined in collaboration with physicians and relevant clinical users. Second, medical equipment specialists should assess the technical compliance of available options, safety requirements, and maintenance and support arrangements. Third, the total cost of ownership and the healthcare facility’s financial capacity should be evaluated. Finally, available options should be compared and selected using predefined, documented criteria and in accordance with applicable procurement and tendering regulations.
Establishing or strengthening specialized medical equipment procurement committees, with representatives from clinical departments, medical equipment management, hospital administration, finance, and procurement, could improve the quality of these decisions. The rationale for selecting the final option, the results of technical and economic assessments, and any deviations from the expert evaluation and ranking should also be documented and made traceable.
Importantly, the professional assessment provided by medical equipment specialists should not be treated as a mere formality. It should have a clearly defined, documented, and assessable role in the formal decision-making process. At the same time, this approach does not mean granting exclusive decision-making authority to a single specialist or removing the powers of legally authorized bodies. Its purpose is to prevent individual-driven decisions and promote a participatory and accountable process.
From Purchasing Devices to Managing Their Entire Lifecycle
One of the essential requirements for reforming procurement is to consider the total cost of ownership throughout the equipment’s operational life. A device with a lower initial price may ultimately impose greater costs on a hospital because of expensive spare parts, limited technical support, or frequent breakdowns. By contrast, an informed selection based on documented assessments can reduce hidden costs, improve equipment availability, and enable more effective use of public resources.
From this perspective, medical equipment procurement should be considered part of a comprehensive policy for managing capital assets across the healthcare system. Such a policy should cover the entire lifecycle of a device, from needs assessment and selection to installation, training, maintenance, performance evaluation, and eventual replacement.
Conclusion
Reforming the selection of medical equipment brands and models depends less on changing individuals than on improving the rules and mechanisms governing decision-making. Balancing clinical needs, technical assessments, economic considerations, and legal requirements can help make procurement more transparent, reduce long-term costs, and improve the quality of healthcare services.
The ultimate goal is neither to restrict physicians’ input nor to give one organizational unit greater authority. It is to establish a system in which no significant decision involving public expenditure is made without adequate professional assessment, documented justification, and appropriate accountability.
