Strategies for Medical Clinics to Buy New Medical Devices/Equipment in Different Countries

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  3. Strategies for Medical Clinics to Buy New Medical Devices/Equipment in Different Countries

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USA

Medical doctors and medical clinics in the US learn about and buy new medical devices/equipment from medical device sales reps, promotional videos, medical/healthcare conferences, medical journals, and printed or emailed mailings/newsletters.

How do medical doctors and clinics learn about new medical devices?

  • The way doctors and clinics learn about new medical devices in the US include dinner meetings, sales rep presentation, doctor conferences, medical journals, and medical device company brochures, and printed or emailed mailings/newsletters from pharma/device companies.

Which medical resources do licensed practitioners trust and access most?

  • According to a study of doctors that influence medical device purchase, the most valued source of information was dinner meetings (31%), device or equipment sales reps (in-person or e-detailing) (29%), promotional video (28%), Past issues of medical journals (printed editions) (28%), and printed or emailed mailings/newsletters from pharma/device companies (20%).
  • A different study found that physicians preferred in-office demos and trials (24%).

Which sites online do medical professionals use/visit the most?

  • Websites medical professionals in the US use the most include Pubmed, MedScape, WebMD, WHO, UptoDate, ClinicalKey, MedicineNet, American Medical Association, NIH, and Epocrats.

How do medical doctors and professionals buy medical devices/equipment?

  • Medical devices are mainly purchased from manufacturers. Manufacturers in the US typically market to hospital administrators, clinicians, HMOs, and government institutions like Medicare directly and sell the products directly.
  • According to a recent Frost & Sullivan research, hospitals are more ready to buy medical equipment via a B2B digital marketplace that provides transparency, customization, and competitive price for reliable medical devices, implants, and consumables.
  • Many healthcare providers in the US purchase medical devices with the help of group purchasing organizations (GPOs). “GPOs are intermediaries that negotiate purchasing contracts with medical device companies (and other suppliers) on behalf of the providers who are members of the GPO, using their combined purchasing power to obtain lower prices.”
  • However, GPOs play more role in purchasing conventional medical devices than in the purchase of more sophisticated/high-technology devices.
  • There are about 600 GPOs in the US but the top five account for 90% of all GPO medical device sales.

What do medical professionals/clinics look for in a medical device?

  •  FDA approval for a medical device is a basic requirement to sell medical devices in the US. Hence, although it is one of the things hospital administrators take note of, it is not a differentiating factor or a competitive advantage.
  • Demonstrating value is critical for medical practitioners in the United States. According to a Boston Consulting Group report, the Affordable Care Act and the Centers for Medicare & Medicaid Services (CMS) have begun to tie joint replacement payment to quality measures. Care bundles for 48 more medical illnesses have been effectively implemented, and by 2018, 90% of CMS services will be paid on a value-based basis.
  • Other key factors considered include ease of use, long-term value, of equipment, product standardization, the requirement for training, and pricing.
  • Additionally, a research discovered that doctors in the United States of America like to see information on how the product would enhance existing practices (14%), as well as supporting data and safety information (13 percent ).

Are there any other special considerations?

  • Medical devices that cost more than $10,000 typically require more inputs from various stakeholders and required more approvals at various levels.
  • Terms also often change to long-term payment plans and the cost is deferred overtime when the equipment costs $10,000 or more.
  • Although targeting physicians and clinicians is great for medical device companies, a study by Bosting Consulting found that targeting hospital and healthcare administrative decision-makers is far more effective for medical device companies.
  • According to a research conducted by Bosting Consulting, businesses with a primary emphasis on clinicians produce revenues per sales representative that are on average between 35% and 50% of those generated by companies with a commercial strategy aimed at administrative decision-makers. (Companies that employ a mix of the two models have revenues per sales representative in the center of that range.)
  • Medicare accounts for the major share of medical device purchases in the US. However, “Medicare does not pay medical device companies directly for their products. Instead, the program reimburses health care providers—such as hospitals and physicians—when they use medical devices to deliver care. Second, Medicare rarely makes payments for individual medical devices. Instead, reimbursement for a medical device is typically part of a bundled payment that covers many of the items needed to deliver the associated service or procedure.”

Canada

The Canadian Medical Association Journal (CMAJ) is a top medical resource and the Canadian Medical Association (CMA) website is among the key online sites visited by medics. Medical professionals and clinics in Canada will only purchase portable ultrasound devices that meet the FDA standards.

How They Learn

  • A study conducted by Policy & Medicine revealed that about 71% of oncologists relied on sales representatives for new medical information, about 44% relied on a combination of medical journals, medical conferences, and sales representatives to get news medical information.
  • About 42% relied on internet searches, about 50% relied on clinical support platforms, and about 60% relied on top opinion leaders. Since oncologists are among the top users of medical devices globally, including Canada, we assumed that these statistics are a reflection of how medical doctors and clinics learn about new medical devices in Canada.

Top Medical Resources

  • The Canadian Medical Association Journal (CMAJ) reported that it had a significant impact on Canada’s health sector.
  • CMAJ indicated that it produces publications on various health issues, including original clinical research, reviews of clinical topics, and thought-provoking health editorials.

Popular Online Site

How Doctors Purchase Devices

What They Look For

  • According to Thomson Reuters, all medical products in Canada including medical devices are regulated by the Food and Drugs Act (FDA).
  •  FDA has the mandate of ensuring that the safety of Canadians in the manufacture, sale and advertisement of all medical products.
  • We assumed that medical professionals and clinics in Canada will only purchase portable ultrasound devices that meet the FDA standards.

Special Considerations

  • The range of issues surrounding the manufacture and use of medical devices, including portable ultrasound devices in Canada can be found here.
  •  Canada mandates compliance with ISO 13485:2003 for producers of Class II, III, and IV medical equipment, including portable ultrasound machines.
  • Unlicensed medical devices may be used in Canada but such usage must be approved by Health Canada’s Special Access Program.

UK + Ireland

The National Health Service (NHS) is the UK’s largest purchaser of medical devices and it greatly influences how medical doctors and medical clinics in the UK and Ireland learn about and buy new medical devices/equipment.

New Medical Devices, Resources, and Sites

  • Medical doctors and clinics in the UK and Ireland would likely learn about new medical devices in the market through the NHS Supply Chain catalog since most purchases are made by the National Health Service (NHS) which is publicly funded. The NHS purchases medical supplies and devices and delivers them to hospitals.
  • The NHS is the largest purchaser of medical devices and it is responsible for around 85% of healthcare provision in the UK and it caters for 84% of the population.
  • Within the NHS, medical supplies including medical devices are mostly procured by acute hospital trusts.
  • They can purchase products through central procurement organizations or hubs, they can also purchase goods individually, or by forming consortia with other trusts for the purpose of making procurement decisions.
  • Hospital trusts mostly rely on the NHS Procurement Portal and the NHS Supply Chain sites to place their order for medical devices.
  • They are also required to publicize their procurement contracts valued at over £10,000 on Contracts Finder.
  • Medical doctors and professionals who are part of the NHS system purchase medical devices/equipment in the UK through their trust via the NHS Supply Chain platform. There are currently 240 trusts in the UK.

Approval/Certification and Special Considerations

  • Medical professionals and clinics in the UK will look for a CE mark and Medicines and Healthcare products Regulatory Agency (MHRA) registration in a medical device. All medical equipment must have the CE mark. This mark indicates that the device is safe and will function properly, provided it is used correctly.
  • However, from 1 July 2021, companies will be required to obtain the new UK Conformity Assessed (UKCA) mark in place of the CE mark in order to sell medical devices in the UK.
  • From January 2021, all medical devices entering the UK market are to obtain registration with the MHRA.
  • A grace period will be given for registering for the following: Four months for Class III and Class IIb implantables, as well as all active implantable medical devices; eight months for all other Class IIb and Class IIa devices; and twelve months for Class I devices. Manufacturers of Class I devices and generic IVDs that are presently obliged to register with the MHRA will be exempt from the 12-month grace period.
  • The private health sector is a much smaller portion of the market and it is funded via health insurance, self-pay patients, or NHS referrals. Due to the market’s inherent characteristics, private sector development is inextricably connected to the performance, policy, and financing of the public sector’s key services.
  •  Non-NHS providers can also place orders through the NHS Supply Chain platform after meeting some required criteria.

Germany

Medical doctors and clinics in Germany learn about or buy new medical devices through trade fairs, medical device information databases, and leading manufacturers’ websites. More details on how they learn about and buy new medical devices/equipment can be found below.

Learning About or Buying New Medical Devices

  • The Federal Institute for Drugs and Medical Devices (BfArM) operates an information system via the internet that provides knowledge around new medical devices and supports their acquisition. Therefore, medical doctors and clinics learn about new medical devices through this database.
  • Many leading medical device manufacturers in Germany, such as B. Braun Melsungen and Siemens Healthineers, have their products grouped by medical specialty on the official websites so doctors can quickly locate all available products relating to their fields and review resources on them.
  •  MEDICA, MT Connect, and OTWorld are important trade fairs for the medical device industry in German. Medical clinics and doctors will likely visit such trade fairs to obtain information and acquire new medical devices.

Online Medical Resources

  • The German Institute For Medical Documentation And Information (DIMDI), a government agency, maintains a database that makes medical device information available to the public. 
  •  Medscape, which is accessible in German, is a high-quality physician-focused website. Since its inception in 1995, the site has garnered praise from doctors and the information industry alike.

How They Buy

  • Medical clinics and physicians in Germany purchase medical equipment directly from overseas manufacturers with a field sales force, through established medical wholesalers with a regional/territorial distribution network, or from designated agents or manufacturer representatives.

What Medical Professionals/Clinics Look for in Medical Devices

  • Medical devices sold and used in Germany must bear the CE marking. This is an essential requirement that medical doctors and clinics will consider while purchasing medical equipment.
  • According to a survey of 9,000 doctors; which could apply to doctors everywhere, “doctors prefer positive patient outcomes and user-friendliness over cost and design when purchasing medical devices.”

France

Medical doctors and medical clinics in France rely heavily on web resources or online publications to learn about or buy new medical devices or equipment. They consult websites like e-marchespublics, achat-hopital, journal-officiel, and other relevant web sites to research and purchase new medical devices or equipment.

Learning About or Buying New Medical Devices

  • Medical doctors and hospitals (including medical clinics) in France depend heavily on web resources or online publications to learn about or purchase new medical devices or equipment. They go through websites like e-marchespublics, achat-hopital, journal-officiel, and similar web resources to find information on new medical devices or equipment.
  • The website of the French Healthcare Association has information on over 80 companies. This information can professionals seeking to learn about valuable medical equipment.
  • Medical professionals from France rely heavily on Medscape to learn about new medical devices. Medscape France has over 240,400 monthly visits. 73.70% of these visitors originate from France. Medscape has several articles that help doctors and other professionals to learn about medical devices.
  • Medical professionals often visit Doctolib to get information, seek support, or offer assistance. Doctolib’s French website has 35.22 million monthly visits. 98.43% of these visits originate from France.
  • Doctolib is the largest provider of electronic health services in Europe. 135,000 professionals or practitioners use Doctolib daily. Doctolib helps healthcare providers to ensure their organization become more profitable

Medical Resources

  • Medical doctors, hospitals, and clinics in France trust online resources published by UniHa, Resah, and Ugap the most. They utilize the resources provided online by UniHa, Resah, and Ugap to purchase new medical devices.
  • Several doctors rely on online resources like the websites of manufacturers of medical devices to learn about medical devices like portable ultrasound scanners. They often depend on website reviews and online testimonials.
  • Sonoscanner (a French leader in the ultrasound device market) equipped over 200 practitioners with ultrasound devices in 2017. The majority of professionals using its website to give testimonies or learn about portable scanners are from France.

How They Buy

  • Some medical professionals (doctors) in France learn about or buy portable medical devices like ultrasound scanners straight from French manufacturers’ websites. Several leaders in the ultrasound device market in France (such as Sonoscanner) provide testimonials and reviews that help doctors learn about their medical devices.
  • Most clinics in France purchase medical devices through purchasing groups or one of the three prominent national ECGs (UniHa, Resah, and Ugap). They depend on tenders published on websites like e-marchespublics, achat-hopital, journal-officiel to make purchases. Tenders refer to prospective suppliers’ submissions in response to the invitation to tender earlier made by a buyer.
  • Clinics depend on appropriate French distribution partners within the hospital sector to purchase devices. These partners are “well acquainted with tenders.”
  • “Almost all [close to 100% of]” purchases made by hospitals (including clinics) in France are made through tenders.
  • UniHa has 1008 member hospitals and 108 hospital groups as its members. It assisted its members to make purchases related to medical devices worth €4.85 billion in 2020.
  • Non-profit private clinics are among the hospitals purchasing medical devices through UniHa, Resah, and Ugap.

What Medical Professionals/Clinics Look for in Medical Devices

  • When purchasing medical devices, medical professionals and clinics look for devices with a registered status. They are looking for devices with a French manual, that are registered with the ANSM (Agence Nationale de Sécurité du Médicament et des Produits de Santéhave), and that have the CE mark.
  • They are looking for devices with a French manual, that are registered with the ANSM (Agence Nationale de Sécurité du Médicament et des Produits de Santéhave), and that have the CE mark.
  • In France, only CE-certified gadgets may be sold. Clinics or professionals interested in reimbursement for purchased medical device’s expenses look for devices that are listed in the LPPR (List des Produits et Prestations Remboursables).

Spain

Medical clinics and hospitals in Spain use official tenders and direct purchases to buy medical equipment from suppliers and distributors.

How They Learn About New Products

  • According to a report by Flanders Investment & Trade, trade fairs are a way for specialists in the medical sector to learn about new medical products, technologies, and trends.
  • Some examples of such trade fairs in Spain include the Orto Medical Care, Expooptica, Euroanaesthesia, Expodental, and Veeva Commercial & Medical Summit.

How They Buy

  • Purchases of medical equipment by medical clinics and hospitals in Spain are made using official tenders and direct purchases from suppliers and distributors.

What They Look For

  • Medical clinics and hospitals in both the public and private sector prefer to purchase new medical equipment rather than refurbished ones.
  • In both cases (new and refurbished), the device/equipment must bear the CE mark and be registered following the Ministry of Health’s guidelines.

Special Considerations

  • “Medical devices used in clinical investigations and customized medical devices” are two types of medical devices that do not require CE marking to be commercialized in Spain.
  • Unlike hospitals and clinics in the public sector, private hospitals do not use official tenders when purchasing medical devices/equipment in Spain. Instead, they make a small selection of suppliers and make direct purchases.
  • Most public hospitals, on the other hand, make use of official tenders. The official tender involves a pre-selection process of the competing companies before the open bid.
  • During this stage, the hospital receives product descriptions and prices from the supplying companies as proposals. After reviewing each proposal, the hospital then chooses the most suitable companies.
  • Non-EU and US companies must have a Spanish distributor or a branch in Spain in order to participate in official tenders and other market opportunities, as well as to provide the required after-care service.

Italy

Medical doctors and clinics learn about new medical devices through advertisements. Some online sites in Italy that medical professionals use or visit include the Italian Journal of Emergency Medicine journal and the Edizioni Minerva Medica journal. Over 75% of medical device sales go to public institutions, and the Italian government is the main consumer of medical equipment. Detailed information is below.

How Medical Doctors and Clinics Learn About New Medical Devices in Italy

  • Through advertisements: Medical doctors and clinics learn about new medical devices through advertisements. According to CMS Legal, advertising of medical devices to healthcare professionals (HCPs) in Italy does not need to be authorized. However, marketing activities can only be directed to HCPs who are authorized to use the medical device. The marketing activities permitted include free samples, verbal information, scientific conventions and congresses, visits to laboratories, and the delivery of promotional material.

Online Sites That Medical Professionals Use/Visit the Most

  •  The Italian Journal of Medicine: The Italian Journal of Medicine is one of the sites used by medical professionals in Italy. It is the official magazine of the Federation of Associations of Hospital Doctors in Internal Medicine and focuses on the complicated and varied circumstances that Internists face on a daily basis.
  •  The Edizioni Minerva Medica: The Edizioni Minerva Medica journal has a catalog list of more than 1,500 scientific titles and targets physicians, nurses, and medical students in Italy. The journal titles represent scientific literature for all medical and surgical specialties.
  •  The Italian Journal of Emergency Medicine (ITJEM): ITJEM is the official emergency medicine scientific journal in Italy. The journal has been in online format since 2016 and is published every four months. The scientific content in English is open to all and features topics of interest for emergency medicine. Numerous reviewers in Europe, especially in Italy, the site reports, are doctors.

How Medical Doctors and Professionals Buy Medical Devices/Equipment

  • According to the International Trade Administration, US Department of Commerce, the Covid pandemic has negatively affected the medical devices market in Italy. The pandemic has increased demand for ventilators and personal protective equipment and a decreased demand for most other medical devices.
  • The Italian government is the country’s largest purchaser of medical equipment. At the start of 2020, the government allocated 235 million euros for the acquisition of basic diagnostic devices such as ultrasound machines, spirometers, and health information technology devices, as part of an Italian healthcare plan to improve local assistance to patients and thus reduce reliance on emergency rooms.
  • The majority of the government’s acquisitions of new medical devices and equipment are done via public tenders that are available to both local and international businesses. Tender announcements for public procurements may be found on the National Procurement Center’s website, CONSIP.
  • Over 75% of medical equipment sales occur in public institutions, with the other 25% occurring in the private sector.
  • Despite the fact that Italy has a sizable domestic manufacturing sector, the domestic market for medical equipment is heavily reliant on imports. Germany, the Netherlands, France, Belgium, and the United States are major providers, with the latter accounting for 5.4 percent of Italian imports worth $374 million in 2018. The most often imported medical devices from the United States to Italy include diagnostic imaging, dentistry, and patient aids.
  • Italy’s medical equipment and supplies industry is Europe’s fourth biggest, after Germany, France, and the United Kingdom, with about 3,957 businesses, comprising 53% manufacturers, 42% distributors, and 5% service providers, and a workforce of 76,400.

What Medical Professionals/Clinics Look for in a Medical Device

  • To ensure compliance with EU legislation, all medical devices sold in the EU must carry the CE mark, which medical professionals and clinics check for.

Australia

In Australia, the government is the main purchaser of medical equipment. Public hospitals usually account for about 70% of medical device purchases, and the private sector accounts for 30%. Medical Professionals/Clinics seek devices that meet the ARTG requirements.

How Medical Doctors and Clinics Learn About New Medical Devices in Australia

  • Through advertisements: Medical doctors and clinics in Australia must comply with the latest review of the Therapeutic Goods Advertising Code. Medical practitioners get information from digital communications channels such as social networking sites, blogs, and discussion forums.

Online Sites That Medical Professionals Use/Visit the Most

  • Medical Journal of Australia: The journal is dedicated to advancing the medical profession by publishing high-quality, clinically relevant material. The company’s website receives about 335,000 monthly views.
  • The RACGP produces and maintains a range of clinical guidelines and sources to support GPs in their practice.
  • AMA provides reliable information for doctors and students medical students in Australia. The AMA collaborates with governments to create and influence health policy that benefits physicians.

How Medical Doctors and Professionals Buy Medical Devices/Equipment

  • According to IBISWorld, Medical practitioners and hospitals depend wholly on federal and state government funding to staff and equip clinics.
  • About 80% of medical devices and diagnostics used in Australia are imported.
  • Australia’s government is the largest buyer of medical equipment, according to export.gov. Public hospitals usually account for about 70% of medical device purchases, and 30% from the private sector.

What Medical Professionals/Clinics Look for in a Medical Device

  • Medical Professionals/Clinics seek devices that meet the ARTG requirements.
  • According to the Therapeutic Goods (Medical Devices) Regulations, all medical devices must be free of infection and microbial contamination; Must have a measuring function; Must be protected against radiation; Must have clinical evidence and more.

New Zealand

Some online sites that medical professionals in New Zealand use or visit are the Pharmaceutical Management Agency (PHARMAC) and Health Navigator. The Medical Technology Association of New Zealand (MTANZ) is the country’s sole industry association representing businesses that produce, import, export, and distribute medical equipment in New Zealand. More details on how medical doctors and medical clinics in New Zealand learn about and buy new medical devices/equipment can be found below.

How Medical Doctors and Clinics Learn About New Medical Devices in New Zealand

  •  Businesses and providers that sell medical equipment provide information surrounding the entry of new devices on their websites.
  • For example, Medical Devices and Testing Limited, New Zealand regularly posts about the availability of new Personal Protective Equipment on its website.
  • There are also conferences that are held in different locations within the country whereby new devices are showcased and available for demonstrations and sale.
  • Advertisements which can be online or through other media also help with learning about new medical devices and these are regulated by MedSafe. 

Medical Resources That Licensed Practitioners Trust and Access Most

  • The Ministry of Health provides valuable information for medical practitioners, with details surrounding any changes to legislation, regulations on COVID-19, and other relevant information that affects the practice of registered practitioners.
  • The Medical Technology Association of New Zealand (MTANZ) which is the “only national industry body representing medical technology companies in New Zealand” has a digital publication called New Zealand MedTech in Action. The MTANZ is made up of local companies and multinationals. The members supply about 95% of the non-pharmaceutical products in NZ in public and private facilities. This includes medical devices and equipment.
  • The Consortium for Medical Device Technologies (CMDT) serves as the single point of contact for New Zealand’s medical technology resources and capabilities.
  • The CMDT and MedTech CoRE are the two components of New Zealand’s national industrial research network.
  • The Tertiary Education Commission funds the MedTech CoRE. It undertakes and publishes research to advance health care via the development of innovative technologies.

Online Sites That Medical Professionals Use/Visit the Most

  • Medical professionals use the Pharmaceutical Management Agency (PHARMAC) which is a government-backed organization that is mandated with managing hospital medical devices. This means that the site provides information surrounding:
  • The Health Navigator is a website that provides the most reliable and trustworthy information for practitioners. This is a non-profit community initiative that is endorsed by the New Zealand government and the Southern District Health Board.

How Medical Doctors and Professionals Buy Medical Devices/Equipment

  • Doctors and professionals buy medical devices directly from private sellers either in-person or online. Most of these businesses source, supply, and service the equipment. Buyers can either purchase these items from the websites or contact the sellers to get different available modes of purchase.
  • Examples of these sellers are:
  • Additionally, New Zealand’s healthcare system is multi-sectoral, including the private, public, and volunteer sectors. However, almost 85 percent of healthcare is financed by the government and provided through District Health Boards. This means that these boards purchase medical devices and the U.S. is the largest source of healthcare products.
  • DHBs advertise tenders for the supply of materials online and PHARMAC negotiates contracts for devices whose manufacturers, importers, exporters, and distributors are represented by the Medical Technology Association of New Zealand (MTANZ).

What Medical Professionals/Clinics Look for in a Medical Device

  • Medical professionals look for approval from PHARMAC which provides a list of the medical devices that its endorses. This is done after consultations with District Health Boards (DHBs), suppliers, and others. The approved devices are deemed as best equipped to deliver local services, the most appropriate ones from a national list, and those that need to be removed.
  • Each District Health Board has a local approved supplier list and this helps medical practitioners when they are looking for equipment to purchase.
  • PHARMAC and DHBs provide lists that can be used to compare manufacturers and their offerings. 
  • According to the Medical Technology Association of New Zealand, all imported medical equipment must satisfy certain criteria. For example, those coming from EU territories should have the CE mark which shows that they have met all the required standards for safety and work.
  • Other independent organizations are also relied on for the provision of information surrounding medical devices in New Zealand. For example, BSI Medical Devices is a globally-recognized organization that provides medical professionals with thorough and robust conformity assessments and certifications.
  • Most of these organizations are:
  • By consulting these bodies, medical professionals get all the information that they require about medical devices.
  •  Medsafe is New Zealand’s Authority for the Safety of Medicines and Medical Devices. This is a unit of the Ministry of Health and medical professionals check to see whether devices are regulated by the authority and whether they meet all the requirements such as labeling and advertising.
  • The distributor of medical devices should register them on Medsafe’s Web Assisted Notification of Devices (WAND) system.

Special Considerations

  • In New Zealand, health professionals are encouraged to report medical device faults and this has led to the highest rate of voluntary reporting worldwide. This is done to Medsafe which is an organization that investigates the problem whenever they deem it to be significant.
September 17, 2021
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