OBJECTIVES: The objective of this research was to examine how regulatory requirements in the inpatient setting impact the uptake and subsequent market presence of MDDs (medical devices and diagnostics).  METHODS: Primary research was conducted through 48 in-depth interviews ranging from 30 to 60 minutes in length. Subjects selected represent key stakeholders from industry, insurance, government, and health services across 9 major markets (EU 5, United States, Japan, Canada, and Australia). Interview questionnaires were designed to understand the national opportunities, market access barriers, and cross-country market dynamics. This was complemented by secondary desk research that included literature reviews, government and other relevant agency websites, and IHS proprietary Healthcare and Pharmaceutical services. RESULTS: The study found that the uptake of innovative devices is affected by the reimbursement environment in hospitals as these serve as the largest consumers of MDDs. While hospitals operate under either global budgets or activity-based funding (DRG system), both funding mechanisms possess limitations to the uptake of new technologies across markets.  Under global budgets, MDDs compete against other technologies and procedures for budget allocation whereas DRG systems use a flat reimbursement rate that acts as a financial disincentive to use more expensive technologies. Interviewees also highlighted additional levers that can affect MDD update, including infrequent coding system revisions, infrequent tariff updates for payments, and the existence of add-on funding mechanisms, which differ across markets.  CONCLUSIONS: Across the markets considered, the inpatient reimbursement framework tends to make for fragmented and subpar uptake of innovative MDDs. Indeed, the hospital funding systems and notably infrequent revision of DRG codes, tariff updates and complex top-up payment systems, when they exist, hamper new technology uptake in an industry where incremental innovation is rapid.