After fifteen years from the first of a series of reforms that introduced managerial paradigms and techniques into the Italian National Health System (INHS), it is possible to provide a critical assessment of the outcomes of such changes. The aim of this paper is to assess how these reforms have changed the INHS, to what extent they concurred to improve the system, where they failed and which issues are still in agenda. To do so we run through the recent history of the INHS and propose an interpretative framework to understand the grounds for its light and shade results. The basis for the analysis is triple. The study draws from researches, literature review, action-researches and field investigations conducted over the last 10 years in the INHS.