Hospitals outsource several activities of the service support in order to focus on the core healthcare production as maintenance service. Recently, faced to the sophistication and the costs of medical equipment that continue to escalate, governments have implemented new reforms to control costs and improve the efficiency and the quality. Hospitals become interested in minimizing the total operational cost, by optimizing healthcare production planning and their support activities. Reorganizing the medical equipment maintenance service becomes a priority for the hospital managers to reduce the cost and the dependency on external parties while ensuring that the medical devices are safe, accurate, and operating at the required level of performance. In this article, we propose an efficient procedure to take the appropriate decisions for medical equipment maintenance such as the selection of maintenance strategy, the insourcing/outsourcing, and the selection of contracts’ type and content. A practical application of this procedure in the Tunisian context is considered. Nevertheless, our procedure is general and can be tailored to hospitals in both developed and developing countries.