In August 2024, St. Vincent's Private Hospital in Australia signed a €40 million agreement with Siemens Healthineers. The press coverage talked about the scanners. The interesting part of the deal was not the scanners. It was the structure: installation, maintenance, and future equipment refreshes rolled into a single predictable payment stream, arranged through Siemens Financial Services. The hospital did not buy imaging equipment. It bought imaging, by the month, from the company that built the machines.
That is the model the three big imaging manufacturers have spent a decade building, and it is why their finance arms matter more than their brochures. Siemens Healthineers reported €21.68 billion in revenue for fiscal 2024, with imaging alone generating €11.84 billion, up 9% year over year. GE HealthCare reported $20.6 billion in revenue for 2025, up 4.8% from $19.6 billion in 2024, with imaging at $9.25 billion. Stryker, whose Flex Financial arm sells pay-per-use and subscription models for surgical equipment, reported $22.6 billion in revenue for 2024 and $25.12 billion for 2025, up 11.2%. These are equipment companies. They are also, quietly, some of the largest healthcare lenders on earth.
The logic is simple and hard to beat. A hospital choosing between a Siemens MRI and a GE MRI is not really choosing between two magnets. It is choosing between two financing packages, two service contracts, two upgrade paths, and two answers to the question of what happens when the machine is five years old. Siemens Financial Services offers hire purchase, finance leases, operating leases, and healthcare loans, and it finances equipment from all manufacturers — a detail that matters, because it means the finance arm can win a deal even when the imaging arm loses one. Philips Capital does the same, with leasing, fixed- and flexible-term loans, pay-per-use agreements, and export-credit-agency-backed financing for cross-border buyers. The manufacturer that controls the financing controls the decision, because the financing is the part the hospital's CFO actually signs.
The weapon works in both directions. A finance arm can make a premium machine affordable by stretching its cost across its useful life, and it can make a competitor's cheaper machine look expensive by refusing to finance it on equal terms. It can bundle software, AI reconstruction, and service into the monthly payment so that the hospital never sees a separate invoice for the things that actually determine image quality. Siemens Healthineers and Philips now embed lifecycle software and guaranteed performance clauses into ten-year managed service contracts, transferring obsolescence risk away from providers, according to Mordor Intelligence. GE HealthCare's OnWatch Predict platform pegs fees to uptime or scan volumes. The sale is no longer a transaction. It is a relationship, priced monthly, that the hospital cannot easily exit.
The certified pre-owned market shows the same logic from the other side. Refurbished systems sell for 40% to 60% less than new, and the OEM pre-owned programs from GE HealthCare, Siemens Healthineers, and Philips are expanding at 11.43% a year. A manufacturer that finances its own refurbished machines gets paid twice: once when the original hospital buys new, and again when the second hospital buys the trade-in, with the finance arm earning interest both times. An independent reseller cannot match that, because it does not control the service contract, the parts supply, or the software license that makes the refurbished machine worth owning.
The counterargument is that this concentration is exactly the problem. When the seller is also the lender, the hospital loses the one protection a competitive market is supposed to provide: an independent party telling it the price is wrong. A finance arm has every incentive to approve a deal its own sales team wants closed, and to structure the payments so the total cost is hard to compare with a rival's. A bank, for all its slowness, at least has no stake in which manufacturer's name is on the machine. The OEM model is efficient precisely because it removes that friction — and removing friction between a seller and a buyer is not always in the buyer's interest.
What happens next is a contest over who owns the monthly payment. The OEMs are moving toward managed services and pay-per-use, where the hospital pays for scans rather than scanners. The banks and independent lessors are moving the other way, toward vendor-neutral financing that lets a hospital mix manufacturers under one agreement. The winner will be whoever can underwrite performance — uptime, throughput, image quality — rather than whoever can underwrite collateral. The scanner is becoming a subscription. The finance arm is becoming the product.
Sources: Mordor Intelligence, Medical Equipment Financing Market: $201.18 billion in 2026, $302.35 billion by 2031, CAGR 8.49%; Siemens €40 million St. Vincent's Private Hospital agreement, August 2024; Siemens Healthineers and Philips ten-year managed service contracts with lifecycle software and guaranteed performance clauses; GE HealthCare OnWatch Predict performance-based contracts; certified pre-owned expanding at 11.43% CAGR, https://www.mordorintelligence.com/industry-reports/medical-equipment-financing-market. Siemens Healthineers fiscal 2024: €21.68 billion revenue, imaging €11.84 billion, up 9% year over year, as reported in Axis Intelligence, AI Medical Imaging Showdown 2025, https://axis-intelligence.com/ai-medical-imaging-ge-vs-siemens-philips/. 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/. Stryker full-year 2024 revenue $22.6 billion; 2025 revenue $25.12 billion, up 11.2%, https://marketcapof.com/stocks/syk.us/revenue/. Siemens Financial Services healthcare finance: hire purchase, finance lease, operating lease, healthcare loans; finances equipment from all manufacturers, https://www.siemens.com/en-gb/products/financial-services/asset-finance/healthcare/ and https://www.siemens-healthineers.com/en-ie/services/sfs. Philips Capital financing services: leasing, fixed- and flexible-term loans, pay-per-use, export-credit-agency-backed financing, https://www.philips.co.nz/healthcare/service/healthtech-leases. Stryker Flex Financial: pay-per-use models, consumables subscriptions, equipment rentals, https://www.stryker.com/at/en/services/flex-financial.html. Medical Outfitters, Radiology Machine Cost by Modality: 2026 Price Table: refurbished saves 40–60% against new, https://medicaloutfitters.com/blog/radiology-equipment-cost/.