Why this index exists
Launching a medical device in Europe is not one decision - it’s a sequence of gates: coding, DRG and add-on reimbursement, policy, and health technology assessment. Two markets can look similar on paper yet behave very differently in practice.
The Index helps you answer:
Where can we get to first meaningful revenue fastest?
Which countries have clear, repeatable market access pathways and which are “case-by-case”?
2026 Med Tech EU Market Access Attractiveness Index
| Country | MAAI |
|---|---|
Germany
|
80
|
Denmark
|
77
|
Switzerland
|
71
|
France
|
63
|
Sweden
|
56
|
Austria
|
53
|
Belgium
|
53
|
Norway
|
53
|
Netherlands
|
43
|
England
|
34
|
Spain
|
34
|
Italy
|
30
|
The 2026 MAAI ranking highlights significant differences across Europe in how achievable market access is for hospital medical devices.
Germany leads the ranking, followed by Denmark and Switzerland, driven primarily by highly predictable pathways and manageable evidence requirements, even where timelines are longer. France stands out as the fastest major market with strong innovation schemes, but ranks slightly lower due to higher evidence demands.
A clear middle tier (Sweden, Austria, Belgium, Norway) reflects reliable but constrained systems, where strong structure is offset by slower timelines, higher evidence burden, or limited flexibility. In contrast, the Netherlands shows that even highly structured systems can underperform when additional decision layers and evidence requirements create friction.
At the lower end, England, Spain, and Italy are held back by a combination of high evidence requirements and multiple access barriers (England), alongside low predictability, regional complexity, and unstructured timelines (Spain and Italy).
Overall, the index shows that predictability and evidence burden, not speed alone, are the strongest drivers of market access attractiveness, with clearly defined and repeatable pathways consistently outperforming more fragmented and resource-intensive systems.
Explore the full report
Request the full report to understand how scores are calculated and how countries compare across each tier in detail. Report is only available to representatives of medical technology companies.
What MAAI measures (6 pillars)
MAAI converts six core market access realities into a single 0–100 score (higher = more attractive).
Counts the practical gates a company must pass (e.g., procedure code, payment mechanism change, national coverage decision, national or local policy, HTA).
How reliably the system behaves: pathway clarity, transparency of criteria, stability of outcomes, and consistency of timelines.
How long does it typically take from the first formal submission/request to a realistic route to payment and acceptance?
The typical clinical and health economic evidence expectations.
Does the country offer innovative payment schemes to support early access for medical devices?
Does this country require laborious regional market access activities in comparison with the national approach?
MAAI is designed for hospital medical devices (implants and invasive devices). It does not cover digital technologies, in-vitro diagnostic tests, or medical aids (devices used in home settings).
Each country receives a score for the six pillars. The overall index is a weighted combination:
Weights are published in the methodology and available on demand to representatives of the medical device industry.