Since outsourcing throughout the 1980s and 1990s, many healthcare organizations are reconsidering their outsourcing decision and backsourcing. This research explores the reasons and outcomes of the outsourcing/ backsourcing decision using a case study approach of two cases in Australia and Italy. Findings indicate that the outsourcing decision was cost-driven alongside a desire to increase workforce flexibility. However, backsourcing occurred due to cost increases, a lack of control and lack of workforce flexibility. On the positive side, contracting was shown to provide the host organization with the opportunity of learning from the contractor in updating skills and practices, and management techniques.