The essay addresses the difficulties which the national and regional levels of government encounter in order to guarantee quality in healthcare services along with financial sustainability. Notably, while the Regions are entrusted with management responsibilities, the State decides on the overall amount of resources devoted to the healthcare system (part of them coming from a regional tax on productive activities and the rest from the state budget). Over the last years the State decreased total funding, and imposed a debt reduction plan on the Regions running a deficit - mostly Southern regions. The results have not met expectations. One of the main problems is that according to original legislative measures on the subject, the Government was supposed to appoint the President of the relevant region as Commissioner in charge of the debt reduction plan, regardless of the extent of his political responsibility for healthcare mismanagement in the region. The briefing note provides an overview of recent legislative reforms aimed at overcoming this paradox while preserving regional autonomy.