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The entrepreneurial medical device repair and maintenance segment of healthcare has rolled with the punches of government regulation and fee-for-service from its humble beginnings in the 1960s and evolved into a sophisticated, hi-tech industry. Competition in the medical device repair and maintenance business is stratified based on service provider. Original equipment manufacturers repair, maintain, and sell equipment manufactured by the company. Some original equipment manufacturers have expanded into full-coverage repair of all hospital medical equipment regardless of manufacturer. Independent service organizations are a very competitive force in the medical device repair industry because of their ability to find niche markets and flexibility in service contracts.