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Table 2 Political strategies and associated pressures

From: Emerging health technology firms’ strategies and their impact on economic and healthcare system actors: a qualitative study

Political strategies
 • Favor representatives visits to establish direct relationships with medical specialists and key actors;  • Emphasize the incremental benefit harbored by the technology;  • Group together as an association to make unified claims;  • Lobby for funding, promoting innovation, and proposing new ways to reach the main users of the technology.
In reaction to
 A new set of rules   • The context of bureaucratization and current budget restriction complicated, codified and institutionalized exchanges between actors;   • A new set of rules has emerged;   • There is a large difference concerning the latitude and the freedom of agency between managers and appraisers, as well as medical specialists.
 An increasing number of actors   • “It can be difficult to explain something very complex in a short message to an increasing number of different actors”;   • Efforts are increasingly targeted towards medical specialists, while less informative information (and therefore, less technical features) is provided to the other actors involved in the acquisition process.
 A misalignment of goals   • The need has to be clearly identified by purchasers and it has to coincides perfectly with the technological offer;   • “The champion is frustrated, because he says we do not understand and yet we have needs; the industry is frustrated because it has a champion, and does not understand why it’s not working; managers are frustrated because they would like to try it but they need more information”;   • “Administrators do not take the patient’s health into account because they rely only on their annual budget”;   • Resistance to change may be much greater than the simple fear towards newness found in the target users of the new technology;   • “Even though we have this study and had the money to do it people must still be prepared to use and pay for it.”
 A complex bureaucratic hierarchy   • “People have new positions in newly recreated decision-making bodies that were not even there when the initial decisions were taken; the latter cast doubt on decisions that have been taken before.”