Since its creation in 1978 the Italian health care system has been delivering a wide range of services and interventions and it is considered one of the most advanced health organizations among the industrialized countries. In accordance with the Italian Constitution, it provides services free of charge to all without any discrimination. The affirmation of the free choice principle, the progressive introduction of private hospitals and the significant increase in health spending have induced the legislator to introduce cost - effective measures to limit cost and satisfy patients' needs. After having examined the profound changes that have been generally influencing the Italian health care system discover how the San Carlo Hospital of Potenza in Italy is trying to rearrange its strategy to detect patients' needs, reduce cost and face challenges posed by emerging competitors.