The Italian National Health Service (NHS) stands at a critical juncture, grappling with the pressing need to reform in response to years of overlooked transformation in the healthcare landscape. Despite significant medical advancements and shifting demographic and epidemiological trends, the NHS has struggled to adapt its institutional structures to meet contemporary demands. Decades of medical innovation have rapidly changed the landscape, yet the NHS's organizational framework has lagged, resulting in inefficiencies and disparities in care. To ensure high-quality, equitable, and sustainable healthcare for future generations, we argue that the NHS must undergo comprehensive reforms. These changes should align healthcare financing, service delivery, and workforce planning with modern medical capabilities and population health needs. A forward-thinking approach is essential, acknowledging the coevolution of healthcare policy and medical science and ensuring that institutional adaptation aligns with the realities of contemporary medicine. By addressing these challenges, the NHS can transform its service delivery mechanisms and maintain its commitment to providing equitable healthcare for all. Overall, to preserve its strengths the Italian healthcare system needs forward-looking reforms that align with the evolving needs of society and medicine.

Keywords: Healthcare system reform, Health system sustainability, Strategic governance in healthcare, Health System Complexity, Italy, SSN.

JEL codes: I1