Public procurement in the medical device sector is complex; it is characterised by dynamism, innovativeness, health and safety, and issues can be politicised quickly. Thus, this sector is different from other sectors that are dominated by price and precise specifications of quality measures. Moreover, public procurement in general is an important political tool for achieving a nation’s objectives. However, political pressures institutionalise unique public procurement practices and rationale to achieve intended and unintended outcomes. These outcomes are also partly due to the nature of the medical device industry. This research aims to develop a framework in which to portray the role of the political and legal environment in shaping the procurement of medical devices outcomes in a European (i.e., Ireland) and an Arabic (i.e. Saudi Arabia) country. An analytical framework was developed to set the theoretical connections between the political and legal environment and the outcomes of the public procurement of medical devices. To understand these connections three models – legal, communication, and award were developed. A qualitative comparative case study approach was adopted which was augmented by in-depth semi-structured interviews with key healthcare procurement experts and secondary analysis. The research identified significant differences and similarities between both countries’ procurement outcomes. Despite efforts made by both policymakers, the institutional logic in practice focuses mainly on efficiency. While, Saudi uses the lowest-cost approach, the Irish system uses MEAT which is supposed to give significant weight to quality and socioenvironmental factors. In fact, both countries eventually focused on cost, with little emphasises on other elements. The theoretical contribution comes from mapping procurement practices in two different contexts. This study expands the scope of existing procurement management knowledge. It also provides an original analysis of the institutional logic in tackling the challenges that pervade the procurement processes. The main implication of this research is that the two systems, although set in different political contexts, have relatively similar outcomes, and both systems require creative solutions to enable socio-environmental factors, quality, and innovation to be reflected and persist. In other words, political pressures, in these two cases seem to be ineffective in mobilising institutionalised practice to achieve the desired outcomes for medical device