The modern National Health Service, resulting from a long evolutionary process and based on the right to health ratified by the Constitution, faces, in an era of increasing economic pressure, important challenges. The uncontrolled increase of the demand for health services (aging population, increased incidence of chronic diseases and disabilities, empowerment of citizen/ patient) and the advent of more and more innovative and expensive health technologies contrast with the difficult economic and financial context of the last decade and the consequent reduction of resources. The growing gap between needs and demand for health on the one hand and available resources on the other strongly undermines the sustainability of the protection of the public welfare, both in the short and the medium-long term. What ways to avoid the collapse? Promote homogeneity of healthcare throughout the country, by avoiding the fragmentation of the national health system in 21 different regional health systems; ensure the appropriateness of prescriptions by avoiding waste associated with excessive useless healthcare; strengthen primary care, social-health integration and continuum of care; invest in prevention. The adoption of these approaches, which would hesitate both in ensuring greater healthcare to citizen/patient and in related cost savings, needs policies aimed to the implementation of structural reforms of our health system.