From hospital availability to patient access: affordability-related barriers to clinician recommendation of innovative medical technologies in Shanghai, China

Background Innovative medical devices and medicines can expand treatment options, but hospital availability does not necessarily translate into patient access. Clinicians are a critical interface between available technologies and patient-facing recommendations. This study examined whether patient affordability constrains this service pathway by leading clinicians to forego recommending innovative medical technologies. Methods We conducted a cross-sectional survey among practising clinicians in Shanghai in December 2025 using the Clinical Adoption Behavior and Cognition Scale for Innovative Medical Devices and Medicines. A total of 824 valid questionnaires were analysed. The primary outcome was frequent affordability-related foregone recommendation, defined as clinicians reporting that they often refrained from prescribing or recommending innovative medical devices or medicines because of patients' economic reasons. Modified Poisson regression with robust variance was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Results Among 824 clinicians, 306 (37.1%) reported frequent affordability-related foregone recommendation, and 678 (82.3%) reported that this occurred at least sometimes. High price or patient out-of-pocket burden was the highest-rated barrier, with 62.9% rating it as serious or very serious. In the fully adjusted model, high perceived price or out-of-pocket burden (aPR = 1.38, 95% CI: 1.09–1.74) and low patient acceptance due to economic or cognitive reasons (aPR = 1.74, 95% CI: 1.39–2.17) were associated with frequent foregone recommendation. Higher institutional support was associated with lower prevalence (aPR = 0.82, 95% CI: 0.70–0.97). Conclusions Affordability-related foregone recommendation of innovative medical technologies was common among clinicians in Shanghai. These findings identify clinician recommendation as an underexamined access point between hospital availability and patient use. Health services policies seeking to improve access to innovation should address patient out-of-pocket burden while strengthening institutional processes, reimbursement information and clinician support.