Abstract
The health care reform it is no longer to be postponed due to the high costs and inefficiencies, as well as differences in the distribution of services, and sharpen existing disparities in the quality of care between regions, according to the health needs of the growing aging population and the introduction of expensive technologies. The paper analyses the main features of the Italian Healthcare System, in particular: 1. Healthcare expenditures; 2. Disease cost (low productivity) (Baumol); 3. Cost-effectiveness as instrument for rational decisions; 4. North-South divide: a matter of extractive and inclusive economic institutions (Acemoglu); 5. Competition in healthcare as part of solution (Porter). The main proposals for reinventing the Italian Healthcare System are the following: 1.Empowering each region for their patients who, as voters, can and should affect the level of appropriateness of the services provided; 2. Utilisation of technologies based on cost-effectiveness appraisals; 3. Diffusion of IT (Information Technology), 4. Competititon based on the results compared to the cost: providers must compete on the outcomes of the services.