Evidence on in-house, outsourced, and centralized hospital foodservice models: a systematic review

Hospital foodservice systems are an essential part of providing healthcare and are critical to patient nutrition, food safety, cost containment, and stakeholder satisfaction. Hospitals have used a variety of culinary and food supply strategies, such as in-house production, complete outsourcing, hybrid arrangements, and centralized catering systems, in response to managerial reforms and financial strains. Even though these strategies are widely used, comparative data about their benefits and drawbacks is still inconsistent. The purpose of this study was to thoroughly examine the literature on hospital foodservice and food supply chain models. A systematic review of 26 articles published from 2003 to September 2026 was carried out. These articles covered countries from varied continents and had various research designs, which included quantitative, qualitative, mixed method approaches. Data analysis was conducted on the basis of the type of model of food supply, examined dimensions (cost, quality, food safety, stakeholder satisfaction), and the strengths and weaknesses associated with each model. The outsourcing model was found to be the most widely researched, especially within hospital support and nutrition services. Research findings reveal that the outsourcing model is capable of saving money if guided by open contracts, proper monitoring frameworks, and regulatory compliance. Nevertheless, there was no direct correlation between cost savings and service delivery quality or food safety improvement. The findings suggest that organizational performance may be associated with governance quality, contractor competence, employee training, and procedural standardization; however, the available evidence does not establish their relative effects compared with the ownership or delivery model. Inadequate execution of GMP and HACCP standards and the lack of integrated supply chain monitoring systems posed serious food safety risks in both in-house and outsourced models. The available evidence does not support a consistent conclusion that one hospital foodservice model is superior to others across all outcomes. The performance of hospital foodservice appears to depend on contextual and managerial factors, including contractual arrangements, regulatory oversight, quality assurance, workforce training, and monitoring mechanisms. Evidence on centralized or off-site production and objective clinical and nutritional outcomes remains limited, highlighting the need for more rigorous comparative and outcome-based research.