This multidisciplinary study aims to analyse how the urban waste management system has changed in the Italian region of Emilia-Romagna, during the decade in which a single regional regulatory unit, the Emilia-Romagna Territorial Agency for Water and Waste Services (ATERSIR), was established and became operational, and the waste management planning was centralized at regional level. Particularly, the following changes have been analysed: i) the methods of municipal waste management (WM), considering waste generation, separate waste collection and waste treatment; ii) the costs of WM service, with a focus on cost of treatment and disposal of unsorted waste; and iii) the urban solid WM policies, in terms of levels of governance, territorial planning and implementation of policies on the regional territory. The period within which the analysis was carried out covers the years from 2008 to 2018, comparing two time frames, before and after ATERSIR establishment. Data at municipal level were gathered and analysed. The results of the technical, economical and institutional assessment show that relevant benefits occurred, such as a constant improvement of environmental performances, the optimisation of the waste flows to plants, a higher level of uniformity of WM cost among Municipalities and a better quality of data collected from waste providers for the technical and economic regulation of the sector. Potential improvements are identified, whilst the institutional reform is positively evaluated in all the analysed aspects.