During the last decade the Italian Health Service has undergone many changes and new laws deeply modified its functioning and financing. This reform is influencing some specific aspects of the system such as the investments in medical equipment and its maintenance. The pressure on efficiency and on cost reduction is pushing the different medical institutions towards a better management of their equipment looking for maintenance contracts able to guarantee a high quality of the service at a competitive price. This implies a reduction in the number of "full risk contracts", which are the most expensive system of technology management and the development of "global service contracts", which allow a strong reduction in costs, but do not guarantee the quality of service. At the same time medical institutions are moving towards the insourcing of the clinical engineering services, a solution which guarantees a better planning of investments, lower costs and higher efficiency.