This white paper explores the structural challenges associated with Health Technology Management (HTM) in modern healthcare systems and highlights the growing need for governance-oriented approaches to medical equipment management. Healthcare institutions invest billions in medical technologies, yet governance frameworks for managing these assets often remain underdeveloped. As a result, hospitals face hidden financial exposure, operational inefficiencies, and increasing lifecycle risks associated with aging equipment portfolios. This publication introduces a governance-based perspective on HTM and proposes a structured analytical framework to assess institutional maturity in managing medical technologies. The paper presents the ATLAS HTM Index, a conceptual model designed to evaluate governance maturity across multiple operational and financial dimensions. Through analytical modeling and benchmark-based estimates, the report illustrates how insufficient governance structures may lead to significant financial exposure for healthcare institutions. The study also examines systemic risk dynamics related to lifecycle management, preventive maintenance discipline, vendor governance, and capital planning. The publication aligns with international HTM standards and guidelines, including those developed by the World Health Organization (WHO), AAMI, and ISO, and aims to contribute to the broader discussion on strengthening governance frameworks for medical technology systems. The report is intended for healthcare executives, biomedical engineering leaders, policymakers, and healthcare system stakeholders seeking to improve the strategic governance of medical technology assets. Contact and collaboration Institutions, healthcare organizations, researchers, and policymakers interested in discussing the findings of this report or exploring collaborative initiatives in Health Technology Management governance are invited to contact the author. Professional inquiries and discussions are welcome via: •⁠ ⁠LinkedIn: https://www.linkedin.com/in/othmane-abouyahia•⁠ ⁠Email: oabouyahia@atlasmedequipment.com•⁠ ⁠Website: https://www.atlasmedequipment.com