In the paper the author analyses the Italian Health spending in relation to public spending, and proposes a new accountability pact between central government and the regions, aimed at relaunching the National Health Service. Following an historical overview of the foundation of the Nhs and the reforms in the 70s and 90s, the relation between funding and spending from 1999 to 2004 is analysed in the light of documents produced by Institutions and Research Institutes, and compared with other European countries. The paper also presents a detailed analysis of health legislation concerning the regions adherence to the Stability Pact, the agreements signed at the State-Region Conference and the critical financial situations presently registered. Lastly, it examines article 119 of Title V of the Constitution and the new funding system of local authorities which it introduces.only subscribers can see the full article