By Incisive Health, Inizio Evoke
What if the key to a more resilient, equitable, and efficient healthcare system lies in the way we purchase medical technologies and services?
Europe’s healthcare systems are under growing pressure – from an ageing population, disparities in access to care, workforce wellbeing challenges, the demands of the green transition and the growing threat of antimicrobial resistance. These challenges underscore the urgent need to place sustainability at the heart of healthcare, ensuring that environmental, social, and economic dimensions are integrated to strengthen the resilience of the healthcare systems and address emerging threats.
The upcoming revision of the EU Public Procurement Directive presents a timely opportunity to put this vision into practice. With a substantial share of healthcare spending managed through public procurement, aligning purchasing processes with sustainability goals could become a powerful lever for change. Embedding holistic, forward-looking criteria into procurement decisions can help build healthcare systems that are environmentally responsible, socially resilient, and economically sound – delivering benefits far beyond cost-efficiency alone.
What does a holistic approach to sustainability in healthcare entail?
On the environmental dimension, sustainability efforts often focus on curbing greenhouse gas emissions and reducing waste within the healthcare sector. However, other significant environmental impacts, such as emissions and waste generated during reprocessing activities, the treatment and disposal of chemicals, wastewater pollution, and inefficient water use, are frequently overlooked in many sustainability initiatives and assessment tools. Understanding this broader environmental footprint, an undertaking that requires collaboration among healthcare providers, industry stakeholders, and policymakers, is essential for developing strategies and criteria that truly minimize the sector’s environmental footprint.
To assess the social dimension of sustainability, it is essential to consider how healthcare practices impact both current and future generations, within and beyond the clinical setting. Advancing patient centricity, equity and timely access to care are crucial steps toward better outcomes and a more sustainable system. But social sustainability also depends on tackling long-term challenges like workforce shortages, declining staff well-being, gaps in emergency preparedness, and the sector’s role in the growing threat of antimicrobial resistance. These interconnected issues demand coordinated EU-level action to protect public health over the long term, including careful consideration of the (indirect) role that medical purchases play in either exacerbating or addressing them.
The economic dimension is equally important, as no healthcare system can effectively serve its purpose amid rising demands without reliable funding. Forward-looking economic sustainability requires innovative financing models and EU-level collaboration in the harmonisation of policy frameworks and integration of best practices in procurement. At the clinical level, where budget pressures are felt most directly, it’s essential to embrace Value-Based Procurement approaches to improve long-term cost-effectiveness while delivering better outcomes for patients. A truly sustainable approach also involves factoring in the full life-cycle costs of products and services.
How can Public Procurement Revision advance sustainability in healthcare?
The EU Public Procurement Directive shapes how public healthcare systems make purchasing decisions. While it focuses on ensuring efficiency and transparency, it has also faced various criticisms for prioritising price over innovation, quality, and sustainability. The ongoing revision, currently being drafted by the European Commission, intends to modernise the document, ensuring it addresses current challenges, including a focus on strengthening the integration of sustainability into procurement procedures and contributing to making the EU's economy greener, more social, competitive, and innovative.
This presents a valuable window of opportunity for all healthcare stakeholders to collaborate in defining what sustainability means within the healthcare context and how the Directive can better address healthcare-specific needs. If sustainability is to be truly integrated and guide procurement decisions for years to come, it is essential to agree on a common approach on how various sustainability dimensions - environmental, social, and economic - interact with one another and together shape the resilience of healthcare systems, affect patient outcomes and impact emerging threats.
While the full picture of sustainability in healthcare is complex, we are not starting from scratch. A growing evidence base already exists to inform further research, inspire best practices, and guide a harmonised EU approach. To build on this foundation, all stakeholders – healthcare providers, procurers, industry, patients, and policymakers – must work together. Aligning procurement with sustainability goals across the full spectrum is a powerful lever for system-wide transformation.
With the Commission’s evaluation report of the Public Procurement Directive expected in Q3 this year and the proposal for revision anticipated in 2026, now is the moment to facilitate the dialogue in ensuring that public purchasing not only delivers value for money, but also value for people and the planet.