The article attempts to shed light on recent developments in the Italian National Health Service, particularly the changes introduced by the reforms of the late 1990s. By strenghtening the role of Regional governments, these measures deeply affected the previous centre-regional balance of powers. The article contrasts the co-operative approach by the centre-left governments which originally introduced the relevant legislation with the confrontational style typical of the following centre-right majority. Considering health funding played a crucial role in the controversy between the national government and the Regions, the article discusses the rationale of legislation on fiscal federalism and its implementation, but also the quantity and quality of health care services provided in the different parts of the country. As the article illustrates, Northern and Central Regions continue to have a higher level of services compared to the South, thereby attracting a considerable number of hospital patients from ill equipped Southern areas. The last part of the article addresses this topical issue and the possibility that inter-regional conflicts might surface, and complicate the situation further, especially in the light of the constitutional reform which the centre-right majority approved just before the end of the legislature.