The contribution analyzes the implications of differentiated regionalism on the protection of the right to health enshrined in Article 32 of the Constitution in light of the normative and constitutional evolution of the National Health Service SSN Following the establishment of the SSN under Law No 833 1978 and the regionalization enacted by Legislative Decrees Nos 502 1992 and 229 1999 the reform of Title V of the Constitution Constitutional Law No 3 2001 assigned concurrent competence in healthcare matters to the Regions reserving to the State the determination of the essential levels of performance LEP However this framework has led to increasing territorial disparities in the provision of health services exacerbated by cuts to public spending and managerial inefficiencies The introduction of fiscal federalism Law No 42 2009 and the standard cost mechanism have not resolved these issues Law No 86 2024 implementing Article 116 paragraph 3 of the Constitution which allows for the attribution of further forms of autonomy also in healthcare matters subject to the guarantee of the LEP has been scrutinized by the Constitutional Court Judgment No 192 2024 The Court identified constitutional issues related to the absence of guiding criteria in the delegation to the Government the use of Prime Ministerial Decrees DPCM for updating the LEP the modalities of sharing state tax revenues and the risk of violation of the principle of equality Differentiated regionalism in the absence of a uniform definition and funding of the LEP therefore risks exacerbating territorial inequalities in access to fundamental rights compromising the uniformity of the right to health throughout the national territory Consequently a possible recentralization of healthcare competences is envisaged aimed at ensuring uniformity and social cohesion enhancing the LEP as a guarantor instrument and promoting tools for more efficient and sustainable management of public healthcare expenditure.