National laws and regulations on service delivery systems (SDS) for assistive technology (AT) in Europe aim to support the activity and participation of people with disabilities. The aim of this paper was to study similarities and differences in the SDS for AT of one Eastern and one Western EU member state. The legislation and regulations, and their operationalization were described from the perspective of key actors, with a focus on the ageing population. Semi-structured interviews (N = 14) were conducted in Sweden and Latvia. The informants had various professional backgrounds and organizational roles, and represented different areas of work. Similarities found were connected to legislation and policy, the aim of AT provision, the growth of a private sector and how financial resources affect the SDS. Differences were related to the availability of AT, and to how, and for and by whom the devices were provided, with Latvia prioritizing certain groups over others and excluding older people. In Latvia, despite it not being stated in the legislation, a medical perspective on AT provision was applied, whereas in Sweden, in congruence with the legislation, the perspective was explicitly biopsychosocial. Despite similarities on the legislation and policy level, interpreted based on the perceptions of professionals there are marked differences between Latvia and Sweden in the operationalization of the SDS of AT. To support activity and participation for the ageing population, the services connected to AT need to be carefully thought out and executed, making efficient use of financial resources and professional competencies.