Italy has a national health service (SSN) dating to 1978. Italy'ssystem of government is characterized by a rather high degree ofdecentralization of power, and the health system is likewisedecentralized. Most of the responsibilities for health care havebeen ceded to the regions. The state retains only limitedcoordinating and supervisory powers. The state has a financialresponsibility for the national health service, but statecontributions are limited and expenditures in excess of this made bythe region must be financed from other sources. Health reforms of1992–93 aimed at making the regions more sensitive to the need tocontrol aggregate expenditure and to monitor measures to promote efficiency,quality, and citizen-patient satisfaction. The diffusion of individualhealth technologies has been relatively uncontrolled in many regionsin Italy, although tight central constraints on capital spending havecontained diffusion of new technology. Regulation of placement ofservices is a planning function and is the responsibility of both theMinistry of Health and the regions. Health technology assessment(HTA) activities have been expanding since the early 1990s, but theseactivities tend to be untargeted, uncoordinated, and withoutpriorities. Nonetheless, the principal actors in the SSN at national,regional, and local levels are becoming more sensitive to the need toapply criteria of clinical and cost-effectiveness and to be morerigorous in deciding what services to guarantee. There are reasons tobe guardedly optimistic about the future of HTA in Italy.