For a medical device company entering China, obtaining NMPA approval is only the first major hurdle.

The next question is often more difficult:

How does a Chinese hospital actually buy the device?

For companies accustomed to the U.S. or European markets, China's hospital purchasing system can appear opaque. A physician may strongly support a technology, but that does not mean the hospital can immediately purchase it. A product may have NMPA approval, yet still need to pass hospital planning, budget approval, internal technical assessment and a formal procurement process.

And in 2026, several important policy changes are making this process even more relevant.

For global MedTech companies, the basic lesson is:

NMPA approval gives a product permission to enter the market. It does not guarantee access to a hospital.

Hospital access is a separate process.

The Short Answer: How Does a Chinese Public Hospital Buy Medical Equipment?

A typical capital-equipment purchase may involve the following stages:

The exact route varies according to the hospital, source of funds, equipment category, purchase amount, local government rules and whether the product is included in a centralized procurement catalogue.

There is therefore no single national purchasing process that applies identically to every device purchase at every Chinese public hospital.

But the underlying logic is broadly consistent:

clinical need → internal approval → budget → procurement → contract → installation and acceptance.

The Purchase Usually Starts Before the Tender

International suppliers sometimes focus heavily on the tender itself.

In practice, by the time a public tender appears, many important decisions have already been made.

Before procurement begins, the hospital usually needs to determine:

• why the equipment is needed;

• which department will use it;

• expected utilization;

• clinical requirements;

• technical specifications;

• approximate budget;

• installation conditions;

• service requirements;

• and whether the proposed purchase fits the hospital's development and equipment plans.

National government procurement rules require purchasers to conduct market research on factors including technology, supply and price, and to develop complete and clear procurement requirements.

A provincial policy from Hunan provides a useful example of how this can work inside a public hospital.

Under the province's guidance, a requesting clinical department first conducts internal evaluation of its equipment needs. The hospital's equipment-management department then consolidates those requests, and an equipment committee evaluates them in light of hospital scale, development plans, specialty development, priorities and opportunities for resource sharing. For projects above applicable government procurement thresholds, market research and further expert review are required before the final budget and technical parameters are determined.

The detailed rules differ across China, so Hunan's procedure should not be treated as a universal national template.

But it illustrates an important commercial reality:

The sale often begins during hospital demand formation, long before the tender is published.

For MedTech companies, this is why clinical education, evidence generation and understanding hospital workflow matter.

A tender is frequently the formal purchasing stage of a decision-making process that began months earlier.

A Doctor's Support Matters — But It Is Not Enough

For sophisticated devices, the clinical department is often an important source of demand.

A surgeon may want a robotic system. An ophthalmology department may want a new phaco platform. A radiology department may request a new CT or MRI. A catheterization laboratory may request an advanced imaging or interventional system.

But purchasing decisions generally involve more stakeholders than the physician alone.

Depending on the hospital and equipment category, participants may include:

• clinical departments;

• medical equipment departments;

• finance departments;

• procurement departments;

• hospital management;

• technical experts;

• information technology departments;

• infection-control or facilities teams;

• and external procurement experts.

The larger and more expensive the equipment, the more important this becomes.

A supplier therefore needs to answer different questions for different people.

The physician may ask:

Does the product improve clinical performance?

The equipment department may ask:

Is it reliable, serviceable and technically compliant?

Hospital management may ask:

How often will it be used, and does the hospital really need it?

Finance may ask:

Where does the budget come from?

Procurement personnel may ask:

Can we purchase it compliantly?

These are different parts of the same hospital-access problem.

Budget Is a Separate Gate

Even when a hospital wants a device, it still needs an approved source of funding.

Government procurement rules link procurement implementation to approved budgets and procurement plans. The implementing regulations require purchasers to prepare government procurement implementation plans based on the applicable centralized procurement catalogue, procurement thresholds and approved departmental budget.

This is particularly important for high-value capital equipment.

A hospital can have genuine clinical demand but still postpone a purchase because:

• the annual equipment budget has already been allocated;

• another project has higher priority;

• the requested system exceeds the available budget;

• capital expenditure is being tightened;

• required approvals are incomplete;

• or the hospital expects a future centralized procurement arrangement.

For sales teams, this means that clinical demand and budget timing need to be understood separately.

A physician saying "we need this system" and a hospital having money available to buy it are not the same thing.

Some Large Medical Equipment Requires an Additional Configuration Permit

Certain categories of large medical equipment are subject to China's Large Medical Equipment Configuration License system.

China maintains a national catalogue dividing covered equipment into Class A and Class B large medical equipment. The current catalogue was issued in 2023.

This creates another potential step before procurement.

For equipment included in the catalogue, the medical institution may need the appropriate configuration authorization before it can purchase and deploy the equipment.

This system applies only to specified large medical equipment rather than medical devices generally.

For multinational manufacturers, the distinction is important:

NMPA registration regulates the product.

A large-equipment configuration license regulates whether the medical institution may configure certain types of equipment.

The two should not be confused.

2026 Introduced a Major Change: More Medical Equipment Is Moving Into Departmental Centralized Procurement

One of the most important procurement developments in 2026 came from China's National Health Commission, National Administration of Traditional Chinese Medicine and National Disease Control and Prevention Administration.

In July 2026, the authorities issued new requirements for departmental centralized procurement of medical equipment.

The policy states that public medical and health institutions nationwide that use funds managed within the budget to purchase medical equipment included in a departmental centralized procurement catalogue must conduct those purchases through departmental centralized procurement.

The wording matters.

It does not mean that every medical device purchased by every Chinese public hospital will now be bought through one national centralized tender.

The policy applies when two key conditions are met:

1. the funds are subject to the specified budget management; and

2. the equipment is included in the applicable departmental centralized procurement catalogue.

But the direction is significant.

For manufacturers of capital equipment, China's purchasing environment is becoming increasingly structured around:

• standardized procurement;

• budget discipline;

• demand aggregation;

• price comparison;

• and procurement compliance.

For some equipment categories, the traditional model of pursuing individual hospitals one by one may therefore become less important relative to larger coordinated procurement mechanisms.

Public Tendering Is Important — But It Is Not the Only Procurement Method

China's Government Procurement Law recognizes several procurement methods.

These include:

• public tender;

• invited tender;

• competitive negotiation;

• single-source procurement;

• inquiry;

• and other procurement methods recognized by the government procurement authorities.

Public tendering remains the principal method for government procurement where the applicable public-tender threshold is reached.

The exact monetary threshold is not one universal number across China. For locally budgeted government procurement projects, provinces, autonomous regions and municipalities can establish applicable public-tender thresholds for different administrative levels.

When a project exceeds the applicable threshold but qualifies for a legally permitted alternative procurement method, approval may be required before another method is used.

This is why suppliers should not assume:

"Chinese hospitals always use public tenders."

A more accurate statement is:

Public tendering is central to hospital government procurement, but the applicable procurement method depends on the project, amount and legal circumstances.

What Does a Medical Equipment Tender Actually Contain?

A government procurement tender normally contains much more than the name of the device.

Under national rules, procurement requirements can cover:

• functions and objectives;

• applicable national, industry or local standards;

• quality and safety requirements;

• technical specifications;

• quantity;

• delivery location;

• implementation period;

• service requirements;

• and acceptance standards.

The tender announcement itself generally discloses information such as the project name, budget, procurement requirements, bidder qualifications and bid deadline.

A real 2026 hospital procurement illustrates this.

In July 2026, Jinan Municipal Government Hospital published a public tender for its first batch of medical equipment for the year. The tender disclosed:

• a project budget of RMB1.171 million;

• a maximum purchase price of RMB1.171 million;

• whether imported products were permitted;

• supplier qualification requirements;

• medical-device registration requirements;

• delivery timing;

• and an electronic bidding process.

For a medical-device manufacturer, public procurement notices therefore provide much more than sales leads.

Aggregated over time, they can reveal:

• demand;

• budgets;

• technical requirements;

• pricing;

• hospital purchasing cycles;

• competitive positioning;

• and market-share trends.

This is one reason MedChina uses publicly disclosed procurement data in its market research.

How Is the Winner Selected?

Price matters, but not every tender is simply won by the company offering the lowest nominal price.

China's government procurement rules provide two principal evaluation approaches for tendered goods and services:

lowest evaluated price and comprehensive scoring.

Under the lowest evaluated price method, bids satisfying all substantive requirements are ranked by evaluated price.

Under comprehensive scoring, the winner is determined according to quantified evaluation factors specified in the tender documents.

For medical equipment, those factors can potentially include areas such as:

• product performance;

• technical specifications;

• service capability;

• delivery;

• warranty;

• training;

• and price,

depending on the tender.

The critical rule is that the evaluation must follow the criteria stated in the procurement documents; criteria not specified in those documents cannot subsequently be introduced as evaluation standards.

This is why reading the actual tender document matters.

Two hospitals buying apparently similar devices can structure their requirements differently.

2026 Also Changed the Meaning of "Domestic Product" in Government Procurement

For multinational MedTech companies, this may be the most strategically important procurement change of 2026.

On January 1, 2026, China implemented a new government procurement policy defining domestic products.

The definition is based primarily on where the product is produced — not on the nationality of the company that owns the manufacturer.

Under the policy, a product can qualify as a Chinese domestic product if it is produced in China and meets the applicable localization requirements.

Critically, the rules explicitly state that:

state-owned enterprises, private Chinese companies and foreign-invested companies are to be treated equally.

That makes the policy strategically important for multinational medical-device manufacturers with factories in China.

A device manufactured by a U.S., European or Japanese company's Chinese operation can potentially qualify as a domestic product if it satisfies the applicable production requirements.

Conversely, a device imported into China from an overseas factory is a non-domestic product for purposes of this policy.

Domestic Products Receive a 20% Price Evaluation Preference

Under the new rules, where domestic and non-domestic products compete in the same government procurement process, the bid price of a qualifying domestic product receives a 20% deduction for evaluation purposes.

This requires careful interpretation.

It does not necessarily mean that the manufacturer cuts its actual selling price by 20%.

It is a procurement evaluation mechanism.

For example, suppose two technically acceptable systems compete:

For the applicable price-evaluation calculation, Product A's RMB10 million bid can be treated as RMB8 million after the 20% evaluation deduction.

The actual procurement and contract price is governed by the bid and award process; the 20% figure is an evaluation preference, not simply a mandatory 20% commercial discount.

For multinational companies selling high-value medical equipment, this can materially affect localization economics.

A Foreign Company Can Receive the Domestic-Product Preference

This point deserves emphasis because "domestic product" can easily be misunderstood as "Chinese-owned product."

That is not what the 2026 policy says.

The policy expressly prohibits discriminatory treatment based on:

• ownership form;

• organizational form;

• equity structure;

• investor nationality;

• brand registration location;

• or other unreasonable conditions.

Foreign-invested manufacturers producing qualifying products in China receive the same domestic-product support as Chinese-owned manufacturers.

For a multinational MedTech company, the strategic comparison may therefore increasingly become:

Import finished equipment into China

versus

manufacture or sufficiently produce the product in China so it qualifies under the domestic-product standard.

That is much more consequential than a simple "foreign brand versus Chinese brand" discussion.

What Counts as "Produced in China"?

The new policy provides a specific definition.

A product must undergo manufacturing, processing or assembly within China's customs territory that creates a new product with a different name and characteristics or use.

Minor operations such as:

• packaging;

• labeling;

• simple painting;

• polishing;

• or repacking

do not count as the required transformation.

The policy also establishes a longer-term localization framework involving:

• the proportion of component costs produced in China;

• and, for certain products, requirements relating to key components and key production processes.

However, this system is being implemented progressively.

The government plans to establish product-specific localization requirements over a five-year period, with transition periods of three to five years when specific requirements are introduced.

Importantly, before product-specific component-cost requirements are implemented, products that satisfy the basic requirement of being produced in China are treated as domestic products for government procurement purposes.

For MedTech executives, this makes the current transition period particularly important.

Imported Medical Devices Have Not Simply Been "Banned"

The introduction of domestic-product preferences should not be interpreted as a blanket prohibition on imported medical equipment.

Actual procurement depends on the relevant government procurement rules and tender requirements.

Individual procurement notices may specify whether imported products are accepted.

For example, the July 2026 Jinan hospital equipment tender explicitly stated that imported products were not permitted for that particular procurement package.

Other projects can have different requirements.

The correct conclusion is therefore not:

China no longer buys imported medical equipment.

It is:

Whether an imported device can participate depends on the applicable procurement framework and specific project, while qualifying products produced in China now receive a clear government procurement evaluation advantage.

For multinational companies, that distinction is crucial.

What Qualifications Does a Supplier Need?

Tender requirements vary, but a medical-device supplier normally needs to establish both general supplier eligibility and medical-device-specific compliance.

The 2026 Jinan procurement provides a straightforward example.

The tender required the relevant medical-device registration certificate or filing documentation.

Where the bidder was a manufacturer, applicable medical-device manufacturing authorization was required. Distributors or agents needed the relevant medical-device distribution license or filing documentation according to China's medical-device distribution rules.

This reflects an important principle:

Winning hospital access requires both product compliance and channel compliance.

A registered device offered through an ineligible distributor can still face procurement problems.

Foreign manufacturers therefore need to consider:

• NMPA registration;

• Chinese registration-holder arrangements;

• manufacturing authorization where applicable;

• distributor qualifications;

• tender eligibility;

• after-sales service;

• installation capability;

• and local commercial infrastructure.

The Tender Is Not the End

Winning the procurement project does not complete the purchasing process.

The supplier must still fulfill the contract.

This can include:

• delivery;

• installation;

• commissioning;

• staff training;

• equipment acceptance;

• documentation;

• warranty;

• maintenance;

• and ongoing technical service.

Government procurement rules and hospital internal controls also govern contract execution and acceptance.

Hunan's public-hospital equipment procurement guidance, for example, requires hospital equipment-management departments, user departments and suppliers to participate in equipment inspection, installation, commissioning and acceptance, with formal acceptance documentation produced.

For sophisticated equipment, service capability can therefore become part of market access itself.

A company has not truly entered a hospital simply because a purchase order has been signed.

The equipment must become operational.

The Entire Process in One Diagram

For a typical high-value medical device, the hospital access process can be summarized as:

NMPA registration

↓

Clinical awareness and demand

↓

Department proposes equipment need

↓

Hospital technical and management evaluation

↓

Budget approval

↓

Configuration authorization, if applicable

↓

Procurement planning

↓

Centralized procurement / public tender / other applicable procurement route

↓

Supplier qualification and bid

↓

Technical and price evaluation

↓

Award and contract

↓

Delivery, installation and acceptance

↓

Clinical utilization

This explains why market access for high-value medical devices in China is rarely a single regulatory or sales problem.

It is a chain.

What This Means for Global MedTech Companies

A foreign company considering the Chinese hospital market should answer at least seven questions.

For high-value technologies, one additional question is becoming increasingly important:

Can the hospital economically sustain use of the device after buying it?

That connects procurement with another part of China's market-access system: medical service pricing and reimbursement.

A hospital may be able to buy a device but still struggle to build sustainable utilization if the procedures it enables lack an appropriate charging or reimbursement pathway.

Procurement analysis therefore needs to connect with reimbursement analysis.

The Most Important 2026 Change for Multinationals

For multinational companies, one policy development deserves particularly close attention.

China's new domestic-product government procurement rules do not simply divide the market into:

Chinese companies versus foreign companies.

They create a different distinction:

products produced in China versus products that do not qualify as produced in China.

That makes localization a procurement question as well as a manufacturing and supply-chain question.

For a multinational selling medical equipment into China's public sector, local production may now influence:

• eligibility in some procurement environments;

• price competitiveness in government procurement;

• supply-chain strategy;

• manufacturing investment;

• and long-term China market positioning.

At the same time, the policy explicitly requires equal treatment of foreign-invested and Chinese-owned manufacturers whose products meet the same domestic-product standard.

This combination makes 2026 an important transition year for China's MedTech procurement system.

The Bottom Line

The Chinese public-hospital market should not be understood as:

get NMPA approval → find a doctor → sell the device.

The real path is more complex:

regulatory approval → clinical demand → hospital planning → budget → procurement → evaluation → contract → installation → utilization.

In 2026, two developments make this structure even more important.

First, China is expanding departmental centralized procurement for specified medical equipment purchased by public medical and health institutions using applicable budget-managed funds.

Second, China's new government procurement domestic-product rules provide a 20% price-evaluation preference to qualifying products produced in China, while explicitly allowing foreign-invested manufacturers to receive the same treatment as domestic Chinese companies.

For global MedTech companies, China market access is therefore increasingly about much more than regulatory approval.

It requires understanding how Chinese hospitals make decisions, how public money is spent, how procurement rules work, and how localization changes the economics of competition.

About MedChina

MedChina tracks China's medical-device companies, product approvals, hospital procurement, pricing and reimbursement policies, market data and industry developments.

Our Policy & Market Access coverage focuses on practical questions for international MedTech companies, including:

• How do Chinese hospitals buy medical devices?

• How does NMPA registration work?

• How are advanced medical technologies priced and reimbursed?

• Which medical devices are subject to centralized procurement?

• How do China's localization policies affect multinational companies?

• How does a new medical technology move from approval to real clinical adoption?

August 19, 2026