You're right, but I'm speculating that most (if not all) of the commercial implants so far have been paid pro bono by the hospitals or local health services themselves under some sort of special budget or maybe charitable arm. The company has released details in the past of arrangements with Spanish hospitals to fund a certain number of implants.
The German agreement is very significant since they will be funding all the implants in the trial and if the trial is successful, that will be a direct line to reimbursement. If the Germans reimburse then there will be a strong case for other governments in EU to do the same.
The TRIPP study, if successful, will be a significant contributor to government reimbursement. Both because the medical profession might support it more and because there will be some RCT evidence.
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