During the thirty-year troubled background of the Italian National Health Service (Ssn) which was introduced by Law no. 833 of December 23, 1978, with the intent of applying the British health system known as "Beveridge model" to our country, Lombardy has set up an innovation with regional Law no. 31 of July 11, 1997 which for many reasons is quite radical. In fact, by integrating the main principles of universality and solidarity at the foundation of the Ssn with those of subsidiarity and freedom of choice, the Lombard healthcare reform has shown a new approach to relations between the citizen-user and the health system and to relations between the government (state/region) and the network of operators (Asl and public and private hospitals).
This new concept, which, amongst other things faces the problem of the conflict of interest introduced by the Italian health system with Law 833/78 and present in all other regions, has led Lombardy to promote an open and pluralistic healthcare model where the typical programmed centralism of the Beveridge type models was surpassed or even largely mitigated by the introduction of tools which granted greater decisional power, at least partially, to the citizen-patient, thus limiting the political discretionary power and the weight of organizational bureaucracy.
The success of the Lombard model, which is expressed in quality and economic efficiency, is documented by the consistent amount of data and processing which make up the second half of the report.
In the first half of the report, after analyzing the original approach of the Lombard health system and the especially significant evolution of hospital activities in the period between 2003 and 2008, the delicate problem of transferring the experience to other regions was faced.
A problem which confronts autonomy, the local characteristics and the different political stances of the Italian regions. However these regions, due to the twofold problem of the world economic crisis and the beginning of fiscal federalism, will not be able to ignore the need to launch amendments to their health systems to reach full efficiency and quality.

Gabriele Pelissero is Full Professor of Hygiene and Healthcare Organization at the Faculty of Medicine and Surgery at Pavia University. Author of two treatises and of more than 200 scientific publications on multiple aspects of preventive medicine and epidemiology; over the past twenty years he has mainly been in charge of healthcare organization, programming and management. He is Executive Vice President of the Hospital Group San Donato and Scientific Manager of IRCCS San Donato Polyclinic. He is committed to promote the scientific institutes in his own disciplinary sector and is also national Vice President of Aiop (Italian association of private hospitals), President of Aiop Lombardy and Vice President of Assolombarda Sanità. He is part of the Technical Secretariat of the Lombard Regional Health Council.