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The decentralisation and federalism process of the healthcare protection system has already determined and will determine differences among the various Regions as regards the actual application modalities of essential assistance levels. Such differences are positive when they represent the local realities' adaptation to the general NHS principles and criteria, but are negative when they represent the consequence of different levels of functionality in the supply system. Therefore, the task would be to implement rules in the State-Region or Region-Health Companies relations able to govern differences, nurturing positive ones and minimizing negative ones similarly to what happens in the medical filed with positive and negative cholesterol. The Lecture aims at taking stock of the effects of the 2001 State-Region agreement, with specific focus on the Veneto region, for the purpose of verifying whether or not it contributed to govern differences for the purpose of obtaining guidelines on how to shape in the future a new rule framework in the relations among the various institutional entities.