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

Authors

DOI:

https://doi.org/10.29073/jer.v4i1.62

Keywords:

Business Models, Circular Economy, Healthcare, Rehabilitation Devices, Remanufacturing

Abstract

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.

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References

Abbas, M., Ferasso, M., Khasawneh, M., & Jasim, W. (2023). Circular economy of medical waste: Novel intelligent medical waste management framework based on extension linear Diophantine fuzzy FDOSM and neural network approach. Environmental Science and Pollution Research. https://doi.org/10.1007/s11356-023-26677-z

Alfina, K. N., Ratnayake, R. M. C., Wibisono, D., & Basri, M. H. (2025). Prioritising performance indicators for the circular economy transition in healthcare supply chains. Journal of Cleaner Health Supply Chains. SpringerLink.

Aquino, R., Martins, J., & Lopes, A. (2024). Circular economy strategies in healthcare systems: Barriers, drivers and performance implications. Sustainability, 16(9), 4021. https://doi.org/10.3390/su16094021

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Bühler, F., Fendt, L., Wittenberg, T., & Hamper, J. (2024). Smart circular economy in healthcare: Introducing the 9R framework. Journal of Cleaner Production, 418, 140128. https://doi.org/10.1016/j.jclepro.2024.140128

Camilleri, M. A. (2025). Cocreating value through open circular innovation strategies: A results-driven work plan and future research avenues. Business Strategy and the Environment, 34(4), 4561–4580. https://doi.org/10.1002/bse.4216

Cano, R., et al. (2025). Advancing the circular economy of healthcare plastics. Resources, Conservation & Recycling.

Carreira, R. J., Ferreira, J. V., & Ramos, A. L. (2024). Circular economy challenges in Portuguese SMEs within the healthcare sector. Sustainability, 16(16), 7009. https://doi.org/10.3390/su16167009

Corte-Real, S., Silva, R., Alves, D., & Pimenta, N. (2022). Management of medical sharps by diabetic patients in Portugal: A cross-sectional study. International Journal of Environmental Research and Public Health, 19(17), 10876. https://doi.org/10.3390/ijerph191710876

Costa, L., & Fernandes, M. (2024). Circular economy in the Portuguese healthcare sector: Regulatory challenges and strategic opportunities. Revista Portuguesa de Saúde Pública, 42(1), 15–27.

Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). Sage.

D’Alessandro, C., Szopik-Depczyńska, K., Tarczyńska-Łuniewska, M., Silvestri, C., & Ioppolo, G. (2024). Exploring circular economy practices in the healthcare sector: A systematic review and bibliometric analysis. Sustainability, 16(1), 401. https://doi.org/10.3390/su16010401

da Silva, J., Mendes, R., & Teixeira, L. (2024). Circularity in medical devices: Regulatory barriers and solutions. Journal of Healthcare Innovation, 12(2), 145–160.

Dovetail. (2024). User research and insights platform [Software]. https://www.dovetailapp.com

Esquível, J. (2019). Circular cities and sustainable health transformation. CORE. https://core.ac.uk/download/pdf/303772824.pdf

European Commission. (2023). The European Green Deal and circular health systems. European Parliament.

Fernandes, M. (2024). Circular economy in the healthcare sector: Application in rehabilitation equipment [Master’s thesis, University of Coimbra]. https://estudogeral.uc.pt/retrieve/276322

Ferreira, A. P., Dias, C., & Fernandes, M. (2020). Waste management practices in regional hospitals in the Algarve. Revista Portuguesa de Saúde Pública, 38(2), 144–152.

Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving integration in mixed methods designs: Principles and practices. Health Services Research, 48(6 Pt 2), 2134–2156. https://doi.org/10.1111/1475-6773.12117

Firmino, J., & Poggi, A. (2024). Eco-design of rehabilitation equipment: The role of 3D printing. Journal of Sustainable Design, 10(1), 50–68.

Glover, J., Champion, D., Daniels, K., & Denny, S. (2024). Healthcare entrepreneurship: An integrative framework. Journal of Business Research, 169, 114278. https://doi.org/10.1016/j.jbusres.2023.114278

Granlund, M., Stirbu, D., & Mikkonen, K. (2024). Regulating artificial intelligence medical devices: Circularity, learning systems and accountability. Health Policy and Technology, 13(2), 100815. https://doi.org/10.1016/j.hlpt.2024.100815

Health Care Without Harm Europe. (2024). Reprocessing as a vital component of greener healthcare: EU focus Denmark.

Henriques, G. (2022). Sustainability and the circular economy: Impacts on the healthcare system in Portugal. ProQuest. https://search.proquest.com/openview/b2285316f1859aaeca47088173d52136/1

Hoveling, T., Nijdam, A. S., Monincx, M., Faludi, J., & Bakker, C. (2024). Design strategies for circular medical devices. Resources, Conservation & Recycling, 208, 107719. https://doi.org/10.1016/j.resconrec.2024.107719

Huijben, J., & van Raaij, E. (2025). ESCH R: Study design and methodology for accelerating hospital circular interventions. PMC.

Kirchherr, J., Reike, D., & Hekkert, M. (2017). Conceptualising the circular economy: An analysis of 114 definitions. Resources, Conservation & Recycling, 127, 221–232. https://doi.org/10.1016/j.resconrec.2017.09.005

Lemos, M. (2023). Geoenvironmental study and sustainability in rehabilitation equipment in Brazil [Master’s thesis, University of Minho].

Mayer, K. (2025). Opportunities and challenges of implementing circular strategies in the German medical device industry. Journal of Cleaner Production.

Meister, J. A., Sharp, J., & Wang, Y. (2022). Assessing long-term medical remanufacturing emissions with life cycle analysis. arXiv. https://arxiv.org/abs/2211.15519

Moshawih, S. (2025). Transforming healthcare sustainability: Circular economy frameworks and quantification of interventions. Journal of Sustainable Health Systems.

NoHarm Global. (2024). Case study: Aarhus University Hospital — Circular procurement for plastics.

Omer, R., Lemos, M., & Zhang, X. (2025). Eco-efficiency in rehabilitation devices: A lifecycle approach. Journal of Circular Health Technologies, 3(1), 22–44.

Organisation for Economic Co-operation and Development. (2023). Circular health systems: Aligning healthcare with sustainability goals.

Quitmann, C., Richter, F., Müller, A., & Schmid, A. (2025). Assessing greenhouse gas emissions in hospitals: Development of an open-access GHG calculator. Journal of Hospital Carbon Management, 2(1), 1–14.

Riker, J. (2023). Circular economy and public management in the healthcare sector [Master’s thesis, Federal University of Amazonas]. https://tede.ufam.edu.br/bitstream/tede/9800/2/DISS_JoabeRiker_PPGEP.pdf

Saha, S., Dutta, S., & Kharbanda, O. P. (2025). Circular healthcare systems: Pathways to climate-neutral hospitals. Resources, Conservation & Recycling, 205, 107843. https://doi.org/10.1016/j.resconrec.2024.107843

Sepetis, A., & Parlavantzas, N. (2025). Organisational behaviour and circular economy adoption in healthcare. Journal of Sustainable Health Management, 6(1), 33–48.

Tashakkori, A., & Teddlie, C. (2010). Mixed methodology: Combining qualitative and quantitative approaches. Sage.

Vanguard. (2025). Denmark allows reprocessing of single-use medical devices [Information note].

Velenturf, A. P. M., & Purnell, P. (2021). Principles for a sustainable circular economy. Sustainable Production and Consumption, 27, 1437–1457. https://doi.org/10.1016/j.spc.2021.02.018

Zocco, F., Sleath, D., & Rahimifard, S. (2024). Towards a thermodynamical deep-learning vision-based robotic cell for circular healthcare. arXiv. https://arxiv.org/abs/

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Published

2026-02-09

How to Cite

Jardim, G. (2026). Circular economy and sustainable entrepreneurship in healthcare in Portugal: Circular business models for rehabilitation equipment. Journal of Entrepreneurial Researchers, 4(1), 080–100. https://doi.org/10.29073/jer.v4i1.62