The article offers a comparative account of the situation of the institutional set-ups for health services adopted in various countries of western Europe. The health service is one of the main fields in which the processes of decentring have been most marked and debated over the years. This study shows how it is not possibile to identify one trend and timing for all western countries. The type of model adopted (insurance-based or a national health service), like belonging to different welfare «families» (the Scandinavian, English, continental or Mediterranean ones), influence the course taken in recent decades by the various public health systems in terms of decentring and, in some cases, of re-centralization.only subscribers can see the full article