Healthcare procurement is an essential step for public systems looking to acquire new solutions – but it’s often a lengthy and complex process, particularly when it comes to innovation procurement.
Innovation procurement refers to the process of purchasing new or significantly improved solutions that are not yet available on the market or still require development. It becomes particularly important when existing options are insufficient, when governments want to stimulate local innovation, or when they need tailored, context-specific solutions.
Procurement processes vary widely across countries, shaped by local regulations, administrative structures and available budgets. For smaller countries such as Andorra, Montenegro, Iceland, Malta and Estonia, these processes can be especially challenging due to limited resources, smaller markets, fewer institutional capacities and more.
What are size-specific challenges?
Smaller countries face a number of disadvantages in negotiations with innovators and large international vendors:
Limited bargaining power: The smaller size of the markets makes it challenging to achieve economies of scale or secure supplies, which often prioritise larger markets. It also means that the costs per unit tend to be higher.
Limited budget: Smaller countries often operate with limited healthcare budgets, making it challenging to prioritise innovation and digital health.
Shortage of procurement experts: Innovation procurement like pre-commercial procurement (PCP) and public procurement of innovative solutions (PPI) requires special knowledge or experts familiar with those special tools. That expertise is not always present in the country or in the local language, as more traditional procurement methods tend to be the standard.
Digital health expertise itself: Procurement of innovative solutions often involves digital health tools. Nick Guldemond, professor of healthcare and public health at the Erasmus School of Health Policy and Management at Erasmus University, points out in a HIMSS TV interview: “Digital health in itself is quite complex and adds complexity to the procurement process. It requires capacity and expertise within organisations.” He adds that “implementation of those innovative solutions should be included in the procurement’s progress. What makes implementation successful, from a technical and change management perspective?”
The winning approaches
In recent years, initiatives across Europe have been launched to simplify and expand access to innovation procurement, especially to countries with fewer resources or less expertise. Examples include:
Joint procurement with other countries: Small countries such as Andorra have been joining forces with neighbouring countries like France and Spain when their needs align to benefit from economies of scale and better offerings. Ideally, digital solutions should be integrated in a standardised way to improve interoperability and functionality while strengthening the European market and economy.
Twinning programs: Twinning programs are pairing countries with experience in innovation procurement with countries with less or no experience so they can learn from each other and share experiences and lessons learned. The pairing is designed to complement the necessary expertise. Countries such as Moldova and Georgia have already benefited from those programs.
“In Europe, we have networks suitable for looking for partners with common needs like traditional health IT networks or more specific ones focused on a disease area like cardiovascular, diabetes, etc., and some specific programs supporting match-making and consortia building,” says Guldemond.
How is the EU Commission supporting equity to innovation?
To boost progress in innovation adoption across Europe, the EU Commission supports several projects. InnoMatch is a project funded by the EIC Innovation Procurement Programme, which aims to support the pilot testing or proof-of-concept demonstration of innovative solutions created by the European Innovation Council (EIC) for public and private procurement customers.
Procure4health is creating an open community to encourage the EU-wide adoption of innovation procurement, based on knowledge sharing; capacity building like twinning, networking and matchmaking; and identification of common needs.
Incareheart is a project for a pre-commercial procurement of innovative ICT-enabled integrated care solutions aimed at advancing multidisciplinary health and care for patients with chronic heart failure.
At HIMSS Europe 2025 in Paris, a dedicated session titled “The Small Countries Problem” in the Bridging Policy and Practice Track on 11 June will further address experience sharing regarding procurement approaches with representatives from Slovenia, Estonia, Iceland and Croatia. See the full programme and join the conference 10-12 June 2025.