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 decision makers 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 an 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 applied. Data was collected using a questionnaire (40 respondents) and parallel semi-structured interviews (27 participants). Both data sets were analyzed and merged. Descriptive statistics and content analysis (categorical analysis) were chosen as data analysis strategies. To assess competences for decision making, a questionnaire retrieving only quantitative data was developed (369 valid respondents) and an 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.

Only a few studies were conducted to support decision makers, most of them related to the workload of the radiology department. No national or international HTA study was used for further support. The decision process is characterized by a bounded rationality, influenced by intuition on the one hand and a consultant decision maker on the other hand. The decision is made in a bottom-up process, where information gathering and consensus building lies in the hands of a committee (hospital employees), although external consultancy is also used. The reasoning and justification for the selection of committee members is unclear. The process is considered bureaucratic, time-consuming, and long. Patients are perceived negatively as stakeholders in the process. Their experiences, needs, and expectations are not considered. Decision makers in Portugal have limited knowledge and training in 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 by establishing an in-house HTA unit, which is able to carry out TA studies considering the hospital context and aiming to inform local management decisions on the investment or disinvestment in medical devices,
3. promote a team consisting not only of multidisciplinary TA researchers but also of professionals from the health institution who are able to carry out HTA studies, and
4. encourage a common language and common values to increase the uptake of HTA studies.

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