Table 6.

Cross case comparison of NHS England and RHS Tuscany cases – Results.

	NHS England	RHS Tuscany cases	Comparison (commonalities and differences)	Explanation for difference
Impact of outsourcing on procurement	Cost savings; Increased sales volume; rationalisation of product range was the reason for outsource	Cost savings; Increased volume and actions; reduction in administrative costs (staff)	Similar types and levels of impact
Impact of outsourcing on logistics	Reductions in inventory cover and Cost-to-serve; Delivery service improved	Reductions in inventory, warehouse management costs and administrative costs (staff)
Market model	Free market modelling resulting in competition, disaggregation of supply and reduced NHS SC market power	Mandated market model leading to standardisation and reduced flexibility of supply	Both market model present opportunities and challenges.	Fundamentally different models. Free market model leads to competition and more choice. Mandated model leads to standardisation but reduced flexibility
Supplier and customer relationships	NHS client organisations need guidance to improve the understanding of the NHS SC value proposition. Lack of transparency increases the information asymmetry	The three ESTAVs struggle in developing effective supplier management system: narrow supply base and potential for conflict with public policy goals	High competition in the NHS reduces opportunity for volume aggregation and reduce prices. In Tuscany, the ESTAVs have a limited control over the supply base and are influenced by policy goals in developing supply management portfolio	In both cases a problem of information asymmetry affects the effectiveness of the process and impacts negatively on the bargaining power of the service provider. In both cases, more transparency and guidance are needed