Circular economy and sustainable entrepreneurship in healthcare in Portugal: Circular business models for rehabilitation equipment

This article examines the circular economy as a strategy for sustainable management and innovation in the healthcare sector in Portugal, with a particular focus on rehabilitation equipment. A mixed-methods approach is adopted, combining a systematic literature review (2019–2025), quantitative simulations comparing linear versus circular scenarios (2024–2029), and semi-structured interviews with industry experts (hospital managers, clinical engineers, and entrepreneurs). The results suggest that circular practices—including remanufacturing/refurbishment, leasing, and servitisation—can reduce total cost of ownership (TCO) throughout the equipment lifecycle and lower associated emissions. However, viability depends on critical parameters such as the share of eligible devices, reverse logistics costs, and certification/traceability requirements. The interviews highlight regulatory barriers, cultural resistance, and operational constraints as key limiting factors, while also identifying market opportunities for healthtech solutions and new circular intermediaries. The article proposes an adoption framework based on three conditions—economic viability, clinical trust, and operational capacity—and a phased roadmap for implementation in Portuguese hospital settings.