The author suggests a reflection on the wide theme of supplementary health insurance schemes, which could help to clarify the real or presumed risks of their diffusion and on the definitions of the most opportune modalities and measures to contrast the risks of diversified access to care services. Considering rather simplistic an analysis which looks at the presence of these schemes as an alternative to the Nhs, the author insists on the centrality of an efficient and effective distribution of essential levels of care. At the same time, he considers opportune and advantageous to overcome hostile positions, that are often the prelude to mechanisms of progressive adaptation that lead to unsatisfactory benefits.only subscribers can see the full article