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Procurement policies affect the proliferation of medical equipment for national health systems, but limited comparative evidence exists on how countries acquire this technology. This paper discusses procurement choices for medical devices in five countries (UK, France, Germany, Italy, Spain) based on a review of published and gray literature and policy documents, as well as expert interviews. All countries have introduced various regulations or policy measures that implicitly or explicitly affect the procurement of equipment, ranging from listed changes in financing mechanisms for equipment procurement. There is also a move towards more centralized procurement with the introduction ofpurchasinggroups or consortia, especially in the UK, France, Germany, and Italy. While some stakeholder groups are involved in procurement activities and have larger, more formalized roles, physicians and governments need to ensure access to the best technology that meets patient needs, aligns with national health care priorities and other sectoral goals.