The Italian Consiglio di Stato raised a request for a preliminary ruling aimed at pushing the Court of Justice to find an adequate balance between the principles regulating public awards, the protection of competition and the contribution of voluntary associations in the health and social sector. The issue was characterized as a ‘competition between non-homogenous actors.’ This article provides the information as to the factual and domestic legal background, which led to the Court of Justice judgment in the Spezzino case (C-113/13).