Biomedical maintenance is definitely expensive, but there are a lot of things which can be done technologically which improve quality AND lower costs: 1) Better remote diagnostics on equipment 2) Designing equipment to be maintained by operators, or shifting to disposable or "use once, return to depot" equipment 3) Generally, looking at life cycle costs for equipment vs. just the purchase price.

For a lot of equipment, the operator is actually highly skilled and trained, and in some cases, is cross-trained to maintain the equipment as well (more true in rural health centers).

Another innovation is moving the equipment around -- the MRI trucks get higher utilization in rural communities than a single MRI center would.

(I only really know the radiology side, although the military biomed shops usually maintain everything)