Bureaucratic discretion and digitalization in healthcare authorities’ public procurement

Titolo Rivista WELFARE E ERGONOMIA
Autori/Curatori Anna Malandrino
Anno di pubblicazione 2026 Fascicolo 2026/1
Lingua Inglese Numero pagine 20 P. 81-100 Dimensione file 263 KB
DOI 10.3280/WE2026-0001007
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This article examines how bureaucratic discretion shapes the digital turn in welfare by analyzing procurement choices of Italian healthcare contracting authorities. Using ANAC administrative data on 342,552 procedures conducted by 120 local health authorities (2019-2023), it maps patterns in award procedures and tools and applies a compositional cluster analysis to identify profiles combining digital instruments and procedural competition. Results show broad reliance on e-procurement platforms and the persistence of paper-based tools, while other e-tools, such as e-auctions and e-catalogues, remain marginal. However, platform diffusion does not combine with greater competition. Differences across clusters are driven mainly by procedure choice, and procedural competitiveness remains negative overall because direct awards and negotiated procedures without prior publication dominate. In the absence, during the period considered, of a strict e-procurement obligation, these findings point to a speed- and convenience-oriented use of e-platforms in healthcare procurement, and to an administrative style that values rapid and discretionary procedures in contractor selection, with potential implications for transparency, supplier access, and possible territorial variation in welfare healthcare provision.

Il presente articolo esamina come la discrezionalità amministrativa influenzi la transizione digitale nel settore del welfare, analizzando le scelte in materia di appalti operate dalle amministrazioni aggiudicatrici sanitarie italiane. Utilizzando i dati dell’ANAC relativi a 342.552 procedure condotte da 120 amministrazioni sanitarie (2019-2023), l’articolo individua modelli ricorrenti nelle procedure di aggiudicazione e negli strumenti utilizzati e applica una compositional cluster analysis per identificare i profili che combinano strumenti digitali e concorrenza procedurale. I risultati evidenziano un ampio ricorso alle piattaforme elettroniche e il persistere di strumenti cartacei, mentre altri strumenti elettronici, quali le aste elettroniche e i cataloghi elettronici, rimangono marginali. Tuttavia, la diffusione delle piattaforme non si accompagna a una maggiore competitività procedurale. Le differenze tra i cluster sono determinate principalmente dalla scelta della procedura, e la competitività procedurale rimane complessivamente negativa poiché prevalgono le aggiudicazioni dirette e le procedure negoziate senza previa pubblicazione. In assenza, nel periodo considerato, di un obbligo di e-procurement, questi risultati indicano un uso delle piattaforme elettroniche orientato alla rapidità e alla flessibilità negli appalti sanitari, nonché uno stile amministrativo che privilegia procedure snelle e discrezionali nella selezione degli operatori economici, con potenziali implicazioni per la trasparenza, l’accesso degli operatori stessi alle procedure e le possibili variazioni territoriali nell’erogazione dei servizi sanitari.

Parole chiave:welfare digitale; e-procurement; discrezionalità amministrativa; appalti sanitari; cluster analysis.

  1. Casula M. and Malandrino A. (2023). Exploring the link between administrative styles and policy output: The case of the Italian Extraordinary Commissioner for the Covid-19 Emergency. European Policy Analysis, 9: 119-141.
  2. Decarolis F., Lotti C. and Spagnolo G. (2021). Emergency procurement and the Covid-19 crisis: Insights from Italian administrative data. In: Bandiera O., Bosio E., Spagnolo G., editors, Procurement in Focus: Rules, Discretion, and Emergencies. Paris: CEPR Press.
  3. Ege J., Gofen A., Hadorn S., Hakman I., Malandrino A., Ramseier L. and Sager F. (2024). Understanding street-level managers’ compliance: a comparative study of policy implementation in Switzerland, Italy, Germany, and Israel. Policy and Society, 43(3): 317-333.
  4. Frigo A. and Mocetti S. (2025). The Effects of Digitalization on the Functioning of the Public Sector: Evidence From E-Procurement. Bank of Italy Occasional Paper, 938: 5-25. DOI: 10.32057/0.QEF.2025.938
  5. Gaeta G.L., Malandrino A. and Di Mascio F. (2026). Transparency or Access? E-Procurement’s Two Paths to Integrity: Evidence From Italy. Regulation & Governance, pp. 1-19.
  6. García-Altés A., McKee M., Siciliani L., Pita Barros P., Lehtonen L., Rogers H., Kringos D., Zaletel J. and De Maeseneer J. (2023). Understanding public procurement within the health sector: a priority in a post-COVID-19 world. Health Economics, Policy and Law, 18(2): 172-185. DOI: 10.1017/S1744133122000184
  7. Geropoulos N., Voultsos P., Geropoulos M., Tsolaki F. and Tagarakis G. (2024). Hybrid model: a promising type of public procurement in the healthcare sector of the European Union. Frontiers in Public Health, 12, 1359155.
  8. Grandia J. and Warsen R. (2023). Procurement under pressure: shifting governance strategies in turbulent times. Public Management Review, online first. DOI: 10.1080/14719037.2023.2281973
  9. Hadorn S., Sager F., Mavrot C., Malandrino A. and Ege J. (2022). Evidence-based policymaking in times of acute crisis: Comparing the use of scientific knowledge in Germany, Switzerland, and Italy. Politische Vierteljahresschrift, 63(2): 359-382.
  10. Hudon P.A., Haren M.T., Gartner J.B., Bergeron F. and Côté A. (2025). Public healthcare procurement strategies in response to the COVID-19 pandemic: A scoping review. International Journal of Health Policy and Management, 14: 8556.
  11. Hupe P. and Hill M. (2007). Street-level bureaucracy and public accountability. Public Administration, 85: 279-299.
  12. Janssen W.A. (2023). Public Procurement Law in the European Union. In: Grandia J., Volker L., editors, Public Procurement. Cham: Palgrave Macmillan. DOI: 10.1007/978-3-031-18490-1_3
  13. Khorana S., Caram S. and Rana N.P. (2024). Measuring public procurement transparency with an index: exploring the role of e-GP systems and institutions. Government Information Quarterly, 41(3), 101952.
  14. Leijon K. and Moberg L. (2024). Limiting bureaucratic discretion? Analyzing the design and exercise of administrative judicial review in the welfare sector. Governance, 38, e12891.
  15. Lipsky M. (2010). Street-Level Bureaucracy: Dilemmas of the Individual in Public Services (30th Anniversary ed.). New York: Russell Sage Foundation.
  16. Malandrino A. (2016). Transnational Information Exchanges between EU Member States’ Contracting Authorities to Reduce Risks and Ensure Integrity in Cross-Border Public Procurement. In: Cantino V., De Vincentiis P. and Racca M.G., editors, Risk management: perspectives and open issues, pp. 872-886. McGraw-Hill Education.
  17. Malandrino A. (2013). Il diritto di accesso ai documenti nelle gare d’appalto e la tutela di interessi commerciali legittimi e della concorrenza. Il Foro Amministrativo CDS, 12: 1803-1833.
  18. Malandrino A. and Sager F. (2021). Can Teachers’ Discretion Enhance the Role of Professionalism in Times of Crisis? A Comparative Policy Analysis of Distance Teaching in Italy and Switzerland during the COVID-19 Pandemic. Journal of Comparative Policy Analysis: Research and Practice, 23(1): 74-84. DOI: 10.1080/13876988.2020.1844544
  19. Malandrino A. and Demichelis E. (2020). Conflict in decision making and variation in public administration outcomes in Italy during the COVID-19 crisis. European Policy Analysis, 6(2): 138-146.
  20. Pedersen K.Z. and Pors A.S. (2023). Discretionary responses in frontline encounters: Balancing standardization with the ethics of office. Journal of Public Administration Research and Theory, 33(1): 80-93.
  21. Plant J.F. (2011). Carl J. Friedrich on Responsibility and Authority. Public Administration Review, 71: 471-482.
  22. Thai K.V. (2001). Public procurement re-examined. Journal of Public Procurement, 1(1): 9-50. DOI: 10.1108/JOPP-01-01-2001-B001
  23. Tummers L. (2012). Policy Alienation of Public Professionals: The Construct and Its Measurement. Public Administration Review, 72: 516-525.
  24. Turner I.R. (2022). Reviewing procedure versus judging substance: How increasing bureaucratic oversight can reduce bureaucratic accountability. Journal of Political Institutions and Political Economy, 2(4): 569-596. DOI: 10.1561/113.00000049
  25. Vaidya K., Sajeev A.S.M. and Callender G. (2006). Critical factors that influence e-procurement implementation success in the public sector. Journal of Public Procurement, 6(1/2): 70-99. DOI: 10.1108/JOPP-06-01-02-2006-B004
  26. Van den Boogaart K.G. and Tolosana-Delgado R. (2013). Analyzing compositional data with R. Berlin: Springer

Anna Malandrino, Bureaucratic discretion and digitalization in healthcare authorities’ public procurement in "WELFARE E ERGONOMIA" 1/2026, pp 81-100, DOI: 10.3280/WE2026-0001007