Breaking the “idling dilemma” of donated medical equipment: a TDABC-based analysis of health policy failure and a pathway to reform

Objective This study addresses the widespread idling and premature scrapping of donated medical equipment in grassroots and remote areas, revealing a key policy flaw: the current system incentivizes “equipment quantity and value” while systematically ignoring the essential “operation and maintenance (O&M) service ecosystem” needed for long-term usability. Methods Using a Time-Driven Activity-Based Costing (TDABC) model, we analyzed a representative case—donating portable ultrasound devices to a high-altitude county hospital with a 5-year bundled service—to precisely quantify hidden long-term O&M costs for the first time. Results The total present value (TPV) of 5-year O&M costs amounts to CNY 324,397.89, accounting for 30.19% of the overall total investment of CNY 1,074,397.89. Sensitivity analysis indicates that this proportion fluctuates between −4.15 and +27.84%. Travel and logistics alone exceed 70% of O&M costs, underscoring how geographic barriers erode policy effectiveness through high support expenses. Conclusion Long-term O&M is a critical yet overlooked constraint; its underestimation is a critical factor likely associated with a “donate-and-abandon” model, potentially leading to resource wastage resources. We advocate shifting health policy from “equipment delivery” to “sustainable service capacity building,” proposing a life-cycle cost–based framework to institutionalize O&M costs and improve equity and efficiency in health resource allocation.