I just read a post on slashdot:
During a recent trip to an eye doctor, I noticed that she was still using Windows XP. After I suggested that she might need to upgrade soon, she said she couldn't because she couldn't afford the $10,000 fee involved with the specialty medical software that has been upgraded for Windows 7. Software written for medical professionals is not like mass market software. They have a limited market and can't make back their money in volume because there isn't the volume for an eye doctor's database product like there is for Office or Quicken. With many expecting Microsoft's upcoming end-of-support for XP to cause a security nightmare of unsupported Windows devices in the wild, it seems a good time to ask how many users may fall into the category of wanting an upgrade, but being priced out by expensive but necessary third-party software. More importantly, can anything be done about it?
Let me briefly give you some insight into a discussion I had a few years ago: I was in touch with a regulator for medical devices as I wanted to understand their approach to patch management for embedded software. The reason behind my ask was, that I talked to hospitals in this country and the CIOs all told me that they are not allowed to patch/upgrade because they would violate the accreditation of the device. So, when I talked to the regulator, they told me that they require only a proper risk management process by the vendor of the device (not an effective, just a process) and from there on they do not want to act. They told me that the hospitals need to increase pressure on the vendors to keep software updated and the vendor does not have the incentive.
This is one of the key scenarios, which scare me around Windows XP end of life. Machines which cannot be upgraded for legal reasons or because of economic pressure as described above.