Though innovation is essential to achieve competitiveness in the medical device industry, it is difficult for most firms in developing countries to invest sufficient resources in research and development (R&D) activities due to their small firm size. Therefore, it is necessary to evaluate a company's R&D performance based on the R&D efficiency, which is R&D output to input, rather than the output itself. Although medical device development (MDD) process in the medical device industry are divided into several stages, moreover, the impact of R&D activities in each MDD stage on R&D performance is still unanswered. This study verifies the difference in R&D efficiency according to three business types: both manufacturing and import, manufacturing only, and import only. The effect of the R&D activities in each MDD phase on R&D efficiency is also verified. The results prove that import-only companies tend to achieve higher level of R&D efficiency than firms engaging in manufacturing-only or both manufacturing and import. However, the difference in R&D efficiency between manufacturing-only companies and both manufacturing and import companies has not been verified. Furthermore, it is also verified that the impact of investment in each MDD stage on R&D efficiency varies depending on business types.