Chapter 16 presents the main results of the first year of the Observatory on the Management of Purchases and Health Contracts (MASAN). The chapter aims to address three issues: 1) how are managed planning and need assessment in centralized purchasing processes 2) how procurement function is organized in local health authorities, taking the example of the re-organization of Lombardy Regional Health System 3) what are the purchasing instruments adopted by Regional Central Purchasing Bodies, in particular framework agreement. The researches were carried out through the consultation of institutional sources (websites of the Italian Regions, Central Purchasing Bodies and of Health Authorities, laws and regional resolutions, National Anticorruption Authority - Transparency Portal and Tenders Electronic Daily-TED) as well as interviews with regional representatives. The results generated during the first year of the MASAN Observatory show how the procurement process and, therefore, the players in the purchasing system play a crucial role in allowing the achievement of adequate levels of efficiency, productivity, effectiveness and affordability of the NHS. The effectiveness of a purchase does not only depend on the intrinsic quality of what is bought, but also on the quality of purchasing process. It is necessary to ensure that purchased goods and services are consistent with clinical needs and delivered at the right time and conditions. In order to achieve not only savings but create value, a greater effort by Regional Health Systems to qualify and empower all involved actors and processes, is needed. This necessarily imposes a strong investment in skills and competencies, both at the hub (region / central) and spoke (local health authority) level. Finally, it is important to start a closer interaction with regional planning and with the market.