As the IT industry was the first to be heavily involved in outsourcing, most studies that have examined the subject do so in the context of computer applications and their contributions.1, 2 Beyond IT, literature examining healthcare outsourcing has generally been descriptive, intended to introduce individuals less familiar with the subject to the broad considerations involved3 or to its benefits via case studies.4 These studies have generally considered the decision from a client perspective. As opportunities are expanding for an increasing quantity and variety of vendors to become involved in outsourcing, a better understanding of the client's decision process and concerns involved is needed so that vendors can better take advantage of these opportunities. Firstly, there is a need for a decision-making framework to delineate the key decision areas. Secondly, vendors need conceptual tools to evaluate each market opportunity in order to understand the customer's decision criteria, the corresponding risks, and the likely ways to influence the decision favourably toward them.