Inflation is no longer the only problem; in recent years, geopolitics is having a significant impact on the healthcare sector.
To the economic consequences of the pandemic, have been added the energy crisis, trade tensions, tariff threats, and geopolitical conflicts, which have profoundly altered international trade by introducing instability and market volatility that pose a very significant risk to healthcare companies.
The deregulation of public contracts was a measure imposed by the European Commission on Spain in 2015 when our country was on the brink of rescue and intervention by community institutions, at a time when there was deflation or minimal inflation.
But the current economic situation in our country is not what led to this decision, with GDP growth rates above those of the main continental economies and with very high inflation.
This new scenario requires providing legal certainty and viability to a sector like Healthcare Technology, so that it can compete and be viable in making its purpose a reality: bringing the best technology to patients so that they have maximum health and quality of life.
The Spanish Federation of Healthcare Technology Companies (Fenin) requests the indexation of public contracts to the CPI. That is, to recover the mechanisms that allow updating the conditions of contracts to the evolution of costs when it makes it impossible to maintain the economic balance with which they were awarded.
"Spain constitutes an exception within Europe due to the absence of indexation, as it prevents the general review of public contracts through CPI and requires formulas based on specific indices, while most European countries maintain more flexible and operational price updating mechanisms. We must enable mechanisms that guarantee that contracts remain viable in a completely different economic environment than that which existed when they were tendered and that access to essential goods for the best health and well-being of the population is not threatened," they explain from the sector.
When a contract ceases to be sustainable
The health technology constitutes one of the pillars of the National Health System. Magnetic resonance imaging equipment, ultrasound machines, prosthetics, surgical materials, monitoring systems, or diagnostic devices are part of a highly innovative sector that requires continuous investments and industrial stability.
However, when companies must bear extraordinary cost increases for years without the possibility of updating contracts, profitability disappears. In fact, one in five companies in the sector reports negative results.
Our health system needs a competitive health industry that can continue investing in improving its products and services. In the medium term, the sector warns, the main victim may end up being the health system itself, which would have more difficulties accessing the most innovative technologies, which are key to obtaining more precise diagnoses and treatments and, therefore, more efficient healthcare.
Also, our economy could be penalized because there could be situations of job loss and reduction of investments in a high value-added sector.
The reform of 2023 has not worked
The Government introduced a modification through Law 11/2023, which, in theory, should allow for the price review in certain public supply and service contracts.
The reform was positively received by the industry but, two years later, it continues to produce no practical effects. The reason is that the regulation links the price update to certain official indicators on raw materials that, in many cases, do not exist or are not applicable to health products.
As a result, the indexing provided by the law has become an impossible mechanism to use. From Fenin, they believe that this situation forces a reconsideration of the system and a return to the model existing before 2015, based on the evolution of the CPI.
A matter of competitiveness
For Pablo Crespo, Secretary General of Fenin, the discussion transcends the strictly contractual sphere and directly affects the competitive capacity of the sector.
"The transformation of our healthcare system to be more efficient and provide more quality to healthcare services involves making strategic alliances with healthcare technology companies to improve clinical processes through new technologies. To achieve this, we must ensure the viability of multi-year public contracts and make them feasible in the medium term. The new geopolitical context requires a more certain contractual environment for companies in the healthcare technology sector," he recently explained in statements to Demócrata.
In his opinion, the events of recent years perfectly illustrate this volatility. "We have had pandemics, Filomena, the wars in Ukraine, and now the conflict in the Middle East, a change in tariff policy... All this situation makes the economy much more unstable and unpredictable. In the last five years, the accumulated CPI has exceeded 20% and, when contracts cannot be updated as costs evolve, the competitiveness of companies is affected and also their ability to bring higher quality technology to our country," he states.
For Crespo, addressing this problem is a strategic priority. "These are challenges we need to face as a system if we want to continue ensuring that our sector can provide the highest quality technology to patients, which is precisely our purpose," he emphasizes.
Much more than a business claim
The position of Fenin is based on a premise: indexation is a structural and strategic measure for the public healthcare system that must preserve the economic-financial balance of contracts that, in many cases, have a duration of several years.
In other words, it is about avoiding extraordinary and unpredictable circumstances from making contracts unfeasible whose execution is essential for the functioning of the healthcare system.
Moreover, the organization believes that recovering indexation would favor greater competition and rivalry in public tenders and would reinforce legal certainty for both administrations and suppliers.
This philosophy is already reflected in the Efficient Public Procurement Guide for Healthcare Technology, developed by Fenin along with experts in public procurement, where it is recommended to incorporate price review clauses that allow maintaining economic balance throughout the duration of the contracts.
The geopolitical factor accelerates the debate
The discussion takes on an even greater dimension in the current international context: the threats of new tariff policies, the growing trade rivalry between major economic blocs, and armed conflicts have increased uncertainty about global supply chains.
For a sector intensive in investment in R&D, talent, and technology and highly dependent on electronic components, raw materials, and international logistics, any disruption can quickly translate into new cost increases.
Precisely for this reason, Fenin has conveyed this need to recover the indexing of public contracts for health technology and pharmaceutical and orthopedic provision to both the Government and European institutions.
Likewise, this claim has also been present in the meetings held during 2025 and 2026 with different regional governments. Recently, Fenin has requested that the upcoming processing in Congress of the Bill on Medicines and Health Products be used to incorporate the indexing of contracts into the text of this legislation.
A debate on the public procurement model
Beyond the economic situation, the discussion reflects a fundamental issue: whether the current public procurement model is prepared to respond to an increasingly uncertain world.
The experience of recent years shows that health, energy, or geopolitical crises can profoundly alter production costs in a very short time. Maintaining completely rigid contracts for several years can compromise their execution and limit the healthcare system's ability to incorporate innovation.
In this context, indexing ceases to be an exclusively economic issue to become a tool of industrial and health policy. The goal, they argue from Fenin, is none other than to preserve a competitive ecosystem capable of supplying hospitals and professionals with the best available technologies and ensuring that patients continue to benefit from innovation in an increasingly complex international environment.