[x1798DE]

> The main issue for more OSS is that for pure software-based solutions (i.e. not the software of a medical device), the biggest cost for an hospital is usually maintenance, not the license, since (obviously) the hospital will want someone responsible for any issue and ready to fix it right away. This is a cost that is more difficult to share with others.

That actually seems like it would make OSS more competitive, not less. The ability to sell services and maintenance contracts really lowers the barrier to open-sourcing your software. When the main thing that customers are buying is your company's expertise with the software, the barrier for releasing your software open source is much lower, and you can reap the benefits that come along with that.