The difficult economical balance, attributed to the weight of the health-related expenditure in relation to the GDP and therefore to the definition of sustainability which marks the 40th anni-versary of the 833/78 law, will showcase whether the best approach is to maintain the health system based on the cultural approach that animated the reform or there is a need to change the register. Personally, I would oppose a possible review that is based on superior fundamental, exceptional principles: generalization and fairness of access to services. The innovations and changes concern all the technical and organizational levels of the health system, which are all too often burdened by slow regulatory, administrative and management procedures. Therefore, it is necessary that the relationship between the decision makers, exchange rates and ongoing expenses is strong enough to respond to the need of flexibility of a health system that is complex and continuously evolving. [Publisher's text].