Breaking the Big Three

The high end of medical imaging was, for a generation, a Western oligopoly: an advanced MRI or CT scanner came from GE, Siemens or Philips. China decided that was a dependency worth ending, and built a two-part machine to do it: domestic champions to make the devices, and procurement rules to make hospitals buy them.

The champions are real companies now. Mindray, China’s largest device maker, ranks among the world’s top thirty by revenue, near $4.3 billion, across patient monitoring, diagnostics and ultrasound.^[1] United Imaging has gone further up the difficulty curve: it reported roughly $1.4 billion in 2024 revenue, sells in more than 85 countries, and builds an ultra-high-field 5-tesla whole-body MRI cleared in China, the US and Europe.^[4] Its overseas revenue grew about 35% in a year, substitution turning into export.

First build the alternative; then make the hospitals buy it. Foreign high-value share fell from four-fifths to seven-tenths in a decade.

The procurement lever

Policy did the pulling. “Made in China 2025” set explicit domestic-share targets for medical devices, half the market by 2020, 70% by 2025, and named ultra-high-field MRI and ECMO as priority technologies.^[3] Volume-based procurement, which pools hospital demand into giant tenders, drove median price cuts around 70%, coronary stents fell 95%, artificial joints more than 80%, squeezing importers and favouring domestic bidders.^[2] Foreign brands’ share of high-value devices duly fell from about 80% to 70% across the 2010s.^[3]

The honest limit: substitution is real but incomplete. Domestic firms now supply most mid-field MRI, but the multinationals retain the lead at the very high end, and there is no clean published figure for high-end localisation; the direction is clear, the finish line is not yet reached.

The signal underneath

Medical devices are a textbook Chinese import-substitution play, with the added feature that the state is both referee and buyer. That makes the policy the primary variable: procurement rules can hand a domestic champion a market faster than any product cycle, and can compress margins just as quickly. The investable pattern is to track localisation tier by tier, mid-field imaging substantially won, ultra-high-end still contested, and to watch which domestic firms, like United Imaging, convert a protected home market into genuine export competitiveness. The Big Three are not displaced; they are, for the first time, on the defensive in the world’s largest device market.