The chief financial officer of a mid-sized American hospital has a meeting on her calendar that no patient ever sees. It is the one where the radiology director asks for a new MRI, and the number on the slide is $2.1 million to $3.7 million for a new 3T scanner — before the room. The suite itself, the shielding, the cooling, the structural work, runs another $500,000 to $2 million, and an all-in 3T suite commonly totals $3 million to $6 million over nine to fifteen months from initiation to commissioning. She does not reach for the checkbook. There is no checkbook for a purchase like this. There is a financing decision, and it will shape the hospital's balance sheet for a decade.
That decision is the quiet center of American healthcare capital spending. Medical equipment is the most financed equipment in the country: in the Equipment Leasing & Finance Association's Industry Horizon Report, published October 26, 2026, 82% of medical equipment acquisitions were financed — the highest rate of any equipment type, ahead of automobiles at 77% — and 80% of healthcare organizations used financing at all. The U.S. equipment finance industry reached $1.51 trillion in 2025, up 8.7% from 2024, with 55.2% of the $2.7 trillion invested in equipment and software financed in some form. Hospitals do not buy scanners. They rent the money to use them.
The choice comes down to three structures, and each one answers a different question. A loan — usually a secured term loan or a tax-exempt municipal lease for a nonprofit hospital — answers the question of ownership: the hospital holds title, depreciates the asset, and keeps the machine at the end. A finance lease does much the same thing with different accounting. An operating lease answers the question of obsolescence: the lender owns the machine, the hospital pays for its use, and at the end of the term the scanner goes back. Operating leases held 41.54% of the global medical equipment financing market in 2025, according to Mordor Intelligence, which sizes that market at $201.18 billion in 2026 and $302.35 billion by 2031, a compound rate of 8.49%. The lease is winning because the technology cycle is faster than the depreciation schedule.
That last point is the one that decides most imaging purchases. A 1.5T MRI bought new in 2026 runs $1.2 million to $2 million; a refurbished one runs $475,000 to $975,000, and a new 64-slice CT runs $625,000 to $975,000, according to Medical Outfitters' 2026 cost guides. The refurbished market saves 40% to 60% against new on most modalities, which is why certified pre-owned programs from GE HealthCare, Siemens Healthineers, and Philips are expanding at an 11.43% compound rate, per Mordor. A hospital that buys outright is betting that a machine with an eight-to-twelve-year useful life will still be clinically competitive in year nine. A hospital that leases is paying someone else to take that bet.
The third structure is the one most outsiders miss: the manufacturer itself as lender. Siemens Financial Services, GE HealthCare Financial Services, and Philips Capital do not merely arrange financing — they bundle it into the sale, with installation, maintenance, and future refreshes folded into a single payment. Siemens' €40 million agreement with St. Vincent's Private Hospital in Australia in August 2024 rolled installation, maintenance, and refreshes into one predictable payment stream. GE HealthCare's imaging business generated $9.25 billion of its $20.6 billion in 2025 revenue. When the company selling the scanner is also the company lending the money, the financing terms are part of the product, and the hospital's negotiating counterpart is wearing two hats at once.
Pay-per-use is the newest wrinkle, and the fastest-growing: Mordor puts its compound growth at 12.77% through 2031. The hospital pays per scan, or per procedure, and the manufacturer carries the utilization risk. It is an attractive idea for a rural hospital that cannot guarantee scan volume, and a dangerous one for a lender that misjudges it. The model only works when the manufacturer can predict uptime and throughput with real confidence — GE HealthCare's OnWatch Predict platform, which pegs fees to uptime or scan volumes, is the clearest example of a manufacturer trying to price that confidence.
The counterargument to all of this deserves its weight. Financing is not free money, and the cheapest scanner is the one a hospital already owns. Interest, fees, and the residual-value assumptions baked into a lease add up to real cost over a ten-year term, and a hospital with a strong balance sheet and stable scan volumes will often do better owning outright than renting. The 82% financing rate is partly a measure of how capital-constrained American healthcare is, not how clever its treasurers are. A system that financed less would be a system with more cash — and the fact that it finances more every year says as much about hospital margins as it does about the appeal of leasing.
What happens next is a shift in who carries the obsolescence risk. As imaging AI, software upgrades, and shorter technology cycles make the scanner itself less durable as an asset, the value moves from owning the machine to guaranteeing its performance. The lenders who win will be the ones who can underwrite uptime and throughput, not the ones who can underwrite collateral. The hospitals that win will be the ones who stop asking what a scanner costs and start asking what a scan costs — and who is willing to guarantee that number for ten years.
Sources: Equipment Leasing & Finance Association, Industry Horizon Report 2026–2027 (October 26, 2026): U.S. equipment finance industry $1.51 trillion in 2025, up 8.7% from 2024; 55.2% of $2.7 trillion equipment and software investment financed; medical equipment most financed type at 82% of acquisitions; healthcare industry most likely to finance at 80%; 23% of acquisitions leased, 14% lines of credit, 13% secured loans, https://www.elfaonline.org/research/industry-overview/horizon-report. Mordor Intelligence, Medical Equipment Financing Market: $201.18 billion in 2026, $302.35 billion by 2031, CAGR 8.49%; operating leases 41.54% share in 2025; pay-per-use 12.77% CAGR; certified pre-owned 11.43% CAGR; Siemens €40 million St. Vincent's Private Hospital agreement, August 2024; GE HealthCare OnWatch Predict performance contracts, https://www.mordorintelligence.com/industry-reports/medical-equipment-financing-market. Medical Outfitters, Radiology Machine Cost by Modality: 2026 Price Table: new 3T MRI $2.1–$3.7 million; new 1.5T MRI $1.2–$2.0 million; refurbished 1.5T MRI $475,000–$975,000; new 64-slice CT $625,000–$975,000; refurbished saves 40–60%, https://medicaloutfitters.com/blog/radiology-equipment-cost/. Five West Financial, MRI, CT & X-Ray Machine Costs in 2026: MRI suite construction $500,000–$2,000,000; all-in 3T suite $3–$6 million over 9–15 months, https://www.fivewestfinancial.com/blog/imaging-center-equipment-cost.html. GE HealthCare full-year 2025 results: $20.6 billion revenue, up 4.8% from $19.6 billion in 2024; imaging $9.25 billion, https://www.medicaldevice-network.com/news/ge-healthcare-reports-fy25-revenue-of-20bn-amid-strong-imaging-demand/.