Abstract

In the Italian National Health Service (NHS), the management of the Covid-19 pandemic has been carried out by a mixture of cooperation and conflict between central government and Regions, rooted in the history of the NHS. The paper analyses the evolution of the NHS governance from its inception in 1978 to 2020, showing that the critical issues exploded in the pandemic were the result of two opposite trends of the last 15 years: the re-assertion of central regulation and the push for more autonomy by Regions. This could bring either to the NHS disintegration or to the raise of more effective mechanisms for State-Regions coordination.