Abstract

The article starts with an historical reconstruction of the evolution of health policies in Italy since the foundation of the National Health System, identifying three main phases. It then examines three main aspects of it which distinguish its peculiar characteristics: public de-financing of health expenditures over time and the creeping privatization it has produced; corporatization and managerialization of the Local Health Authorities and the failed attempts to establish «quasi-markets» in health care delivery; the regional decentralization of the Nhs and the performance of the regional health care systems. Lastly, it identifies five paradoxes which characterize the Italian Nhs and make its sustainability rather precarious for the foreseeable future.