Buying European is not enough: Europe must buy better

The most pressing question in European healthcare procurement is not where our medical technologies are made. It is how we buy them.

That distinction matters because, over the next twelve months, the EU is preparing to spend enormous political capital on the first question and very little on the second. With the Critical Medicines Act now agreed, attention is turning to the Industrial Accelerator Act and the imminent revision of the Public Procurement Directives, both built around the same idea: that public buyers should favour European suppliers and European products. At more than €2.6 trillion a year, roughly 15 percent of EU GDP, public procurement is one of the last meaningful levers national governments still hold. Pulling it feels instinctive right now. In healthcare, however, pulling it without reforming what lies beneath will not deliver the resilience Europe is looking for.

Buying cheap, paying dear

For too long, public procurement of medical technologies has been driven almost reflexively by lowest unit price. Across all sectors, 51.8 percent of public tenders are awarded on price alone. In medtech, that figure rises to 61.8 percent. When a hospital tender focuses exclusively on securing the cheapest scanner, the cheapest implant or the cheapest diagnostic test, it leaves little room to assess broader value. It does not ask what happens to the patient afterwards and outcomes such as recovery times, complication rates or the total cost borne by the system over years of use. It simply rewards the bid with the smallest number on the page.

The consequences are measurable. Case studies[1] on quality-weighted procurement consistently show that higher upfront device costs are offset by reductions in downstream expenditure, from shorter hospital stays to fewer repeat interventions. The patient pays twice: once in worse outcomes, then in the higher system costs that follow. No origin label on a product changes that equation. Price-only procurement disadvantages European innovators regardless of how open or closed our borders are to foreign suppliers. It is a barrier to competitiveness that we constructed ourselves, which means we can dismantle it ourselves.

A customs stamp is not a strategy

MedTech Europe supports a stronger, more resilient European industrial base. Reciprocity matters. Security of supply matters. We have argued for both in our recommendations on the Public Procurement Directive revision.

But a horizontal “Made in Europe” requirement applied to medical technologies would not deliver those goals. Our sector comprises over two million different product types, produced by 38,000 companies, ninety percent of which are SMEs. These products depend on complex global supply chains that source specialised components, materials and expertise wherever they are found. Whether based on the place of final assembly, a minimum share of EU content, or component‑level sourcing requirements, such pass‑or‑fail criteria would fail to capture the real European value created across design, research, manufacturing, and clinical integration. They would also risk shortages and slow the uptake of the very innovations that a smarter procurement system should be rewarding.

If European preference is applied to healthcare at all, it must be defined properly. Research and development conducted in Europe, clinical studies run in European health institutions, regulatory investment and the clinical support infrastructure that surrounds a product in use: these are the substance of European industrial presence, not a stamp on a finished device. Equivalence must be preserved for trusted partners under the WTO Government Procurement Agreement and EU free trade agreements. And preference at the EU level must not become a backdoor to national preferences that fragment the single market we are trying to strengthen.

These are necessary conditions. But they are not a silver bullet.

What genuinely strategic procurement looks like

The revision of the Public Procurement Directives is a once-in-a-decade opportunity, and most of what is needed is already on the table. The Best Price-Quality Ratio, if made the default award criterion in healthcare with quality carrying decisive weight, would immediately change the competitive dynamic for innovative suppliers. Procurement and tender frameworks should move beyond narrow technical specifications and lowest-price logic, and instead assess medical technologies based on their impact on patient and clinical outcomes, operational efficiencies, and environmental sustainability gains. This would allow medtech companies to compete on the real-world impact their solutions deliver, rather than on who can shave the last euro off a unit cost. Pre-tender market consultations, established as a standard step rather than an occasional courtesy, would mean buyers and suppliers align on real clinical needs instead of rerunning yesterday’s tender. A clear, harmonised methodology for identifying abnormally low bids would remove the quiet mechanism by which quality is currently eroded across European hospitals week by week.

MedTech Europe has set out the technical detail of each of these reforms in its procurement recommendations. The architecture is there. The question is whether the revision process will use it, or whether the political energy of this moment will be spent entirely on where things are made rather than how wisely they are bought.

Resilience in healthcare is not built by origin labels. It is built by procurement systems that reward quality and long-term value. Get that right, and European competitiveness follows. Get it wrong, and no preference mechanism in the world will rescue a system that still treats the lowest price as if it were the best deal.