DÜSSELDORF, Germany — Celebrating its 40th birthday, Medica, the world's largest trade fair dedicated to medical devices, showed no sign of a mid-life crisis, let alone any effect from the global financial crisis.

Begun as a modest exhibition called "Diagnostikwoche" (Diagnostic Week) with 135 German exhibitors and 4,700 participants, the three-day event that opened Wednesday has grown to 4,279 exhibitors from 65 countries and will attract an estimated 137,000 visitors, a slight increase over last year.

While the event organizers proudly promote different themes and focal points, the event defies neat categorization sprawling across 16 exhibition halls that resemble an Arab souk more than an orderly German trade fair, and effect only amplified by the cacophony of foreign languages in crowded corridors or shouted halfway around the world through portable phones.

Exhibitors cover every category in the healthcare supply chain from disposable bedpans to high-end scanners including laboratory, diagnostics, physical therapy, orthopedics, consumables, health information systems, furnishings, and textiles.

A fully equipped ambulance or integrated operating room can be bought off the showroom floor, and where medical device manufacturers rarely expect direct sales at a trade show, filling the order book is precisely the goal of executives on the stands at Medica.

Hospital administrators from Germany, Austria and German-speaking Switzerland are regulars at Medica to price out new capital acquisitions or everyday supply contracts in face-to-face negotiations.

As part of Germany's recent €4.7 billion ($7 billion) Economic Stimulus Package, hospitals will receive up to €1 billion ($1.5 billion) for the modernization of local institutions with an estimated 45% allocated to capital equipment purchases.

Medica remains a militantly German event, despite 40 years of international influence, and a showcase for German industry head-to-head in the massive exhibition halls with an invasion of Asian competitors, many of whom began in business less than 10 years ago thanks to technology transfers from German companies.

In a survey of 110 of its 222 members released this week during its 10th Media Seminar, the German medical device trade association BVMed (Berlin) reported participating companies said they grew by an average of just under 4% so far this year and are continuing to hire new staff.

In addition to the stimulus package funding, Germany enacted the Innovation Clause (NUB; Neue Untersuchungs und Behandlungsmethoden) to expedite reimbursement for the adoption of new technologies and treatments in hospitals (Medical Device Daily, Sept. 29, 2009).

In 2009 7,500 NUB applications were approved and 87 new treatments were included in the German DRG system, boosting the early adoption, and sales, of advanced technologies.

"The aim is a competition for the best possible medical technology provision, in order to buck the trend of cut-price medicine," according to BVMed CEO Joachim M. Schmitt, adding "The focus must lie on the quality of medical care instead of on price alone."

Fifty-eight percent of member companies said the focus on healthcare delivery quality instead of price focus has boosted demand for their products.

It is not only the Asians who compete fiercely for a share in the European, and especially German, market, the largest on the continent for population and spending.

The large U.S. pavilion at Medica stands as a solid reminder that American companies tend to dominate key markets, such as orthopedics. (MDD, Oct 29, 2008)

In a survey released at Medica for the British Standards Institution (BSI; Bristol, UK) of 1,100 medical technology executives, Emergo Group Consulting (Austin, Texas) found a fourth of all companies targeting Europe as the single new international market they hope to enter in 2010.

Europe was the dominate target among the largest companies among the survey respondents, of whom 60% are based in the U.S.

It is not only Medica but the medical technology sector generally that continues to advance each year.

In the face of the economic crisis last year 64% of respondents to the BSI survey said they nonetheless expected sales to increase in 2009, while this year a modest but steady increase was reported among executives, of whom 70% said they were looking forward to greater sales in 2010.

Both European and U.S. companies reported positive growth from international markets during the previous three months, and a modest increase in exports from North American companies were attributed in part to the weak U.S. dollar compared to one year ago.