Medical devices play an essential role in health care. For instance, magnetic resonance imaging (MRI)
has revolutionized the way images of the human body are acquired. However, although medical devices
improve diagnosis and treatment, they are also one of the causes of increasing health expenditure. Thus,
the purchase of new technologies and the determination of how and when they should be used are
among the most important decisions made in the health care system in general, and by hospital decisionmakers
in particular.
Health technology assessment (HTA) studies aim to provide a range of stakeholders with accessible,
usable and evidence-based information to guide decisions about the use and diffusion of technology
and efficient allocation of resources. For this reason, HTA acts as a bridge between evidence and
decision-making by ensuring better synthesis, communication and dissemination of information.
However, empirical research on decision processes in the purchase of medical devices is sparse, and a
gap on this topic was found in the literature. The present research focuses on the Portuguese health
system and sheds light on the characterization of decision-making processes by those involved in MRI
purchases, in order to understand the influences of HTA.
In terms of research design, two strategies were chosen, aiming at different objectives. To characterize
the decision-making process a mixed method was chosen. Data was collected using a questionnaire (40
respondents), and parallel semi-structured interviews (27 participants). Both data sets were analysed
and merged. Descriptive statistics were chosen as a data analysis strategy, as well as content analysis
(categorical analysis). To assess competences for decision-making a questionnaire retrieving only
quantitative data was developed (369 valid respondents), and Exploratory Factorial Analysis was
performed, followed by Structural Equation Modelling (Confirmatory Factorial Analysis and Path
Analysis).
Results show that steps in the decision process are well-defined. Cost and suppliers’ characteristics are
seen as the most important indicators to guide decisions. Few studies are performed to support the
decision, and these are mostly related to the workload of the Radiology Department. No national or
international HTA study was used to support any decisions. The decision process is characterized by a
bounded rationality, influenced by intuition and a consultant decision-maker. The decision is a bottomup
process where information gathering and consensus building is undertaken by a committee, although
external consultancy is also used. The reasoning and justification for selection of committee members
is unclear. The process is considered to be bureaucratic, time-consuming and long. Patients are
negatively perceived as stakeholders in the process. Their experiences, needs and expectations are not
considered.
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Decision-makers in Portugal have limited knowledge and training in areas of decision-making, health
informatics, health economics and especially HTA. This may limit their ability to truly understand the
future implications of their purchase decisions.
Recommendations are made to: (1) deepen the present research in particular regarding the elements that
influence the strategies and tactics adopted in the decision-making process for the acquisition of medical
devices (2) foster the uptake of HTA by decision-makers with the establishment of an HTA in-house
unit, able to carry out TA studies considering the hospital context and aiming to inform managerial
local decisions on the uptake or disinvestment of medical devices (3) promote a team comprise by not
only TA multidisciplinary researchers but also by professionals from the health institution able to carry
out HTA studies (3) foster common languages and values to increase uptake of HTA studies
