Bureaucratic discretion and digitalization in healthcare authorities' public procurement

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.