The transition to the circular economy in public health systems is a strategic challenge in the context of the climate crisis and the growing financial pressure on health services. This study aimed to analyze the relationship between technological leadership and performance in the circular economy, evaluating the mediating role of digital maturity. A non-experimental, cross-sectional, correlational-explanatory quantitative design was developed with a sample of 124 public hospitals of medium and high complexity. A Circular Economy Performance Index (IDEC-Health) was built and validated, composed of four dimensions: environmental efficiency, circular waste management, sustainable public procurement and digital operational innovation. The results show that technological leadership is positively and significantly associated with circular performance (β = 0.36, p < 0.001) and that digital maturity acts as a partial mediator (indirect effect β = 0.30; 95% CI [0.18, 0.44]). The model explains 59% of the variance of circular performance. It is concluded that technological leadership constitutes a strategic enabler for hospital sustainability, surpassing structural variables such as size and budget in importance. The study provides a replicable measurement model and empirical evidence for the design of public health policies aimed at the circular economy.