The transformation of the National Health Service, with the main objective of rationalizing public spending, has had a significant impact on the purchase procedures of production factors. Among the main lines of change in the purchasing policy, the diffusion of centralized solutions which seem to offer greater advantages than decentralized models are identified, although not free from limits. By analyzing the experience of Lazio in procuring the home oxygen therapy service, the article compares the two purchase models with the aim of assessing their efficiency. The analysis shows that, although the choice of the most suitable strategy needs to be assessed on a caseby- case basis, the centralized model has actually made it possible to achieve greater efficiency of the service which has been contracted-out.
Keywords: Public procurement, centralization, health system, efficiency.