OBJECTIVES: Italy has a tax-funded National Health System (NHS) that guarantees universal provision of comprehensive care. The central government provides policy and planning framework, defines the Essential Levels of Care and guarantees financial sustainability, while the regions are responsible for healthcare delivery and are liable for any budget deficit.  Since 2005, cost-containment and prescription appropriateness policies were developed in order to make regions more responsible on healthcare expenditure. The aim of this research was to provide an overview of national healthcare expenditure trends before and after the implementation of such policies.  METHODS: Data published by the Minister for Economic and Financial Affairs were analysed to show different expenditure trends in different time periods: before 2005 (period: 2002-2005) and after (2006-2013). RESULTS: National healthcare expenditure from 2002-2013 increased by about €30.28 billion (€78.97 in 2002 and €109.26 billion in 2013/year) with an average annual rate of +3.2%. Trends were different per period, with average annual rates of +5.4% in 2002-2005 and +1.3% in the period 2006-2013; +2.6% increase in the period 2006-2009 and -0.3% in 2010-2013. In the period 2006-2013, healthcare expenditures components - such as healthcare professionals, general practitioners and hospital services - showed a lower average annual growth rate compared with the 2002-2005 period. Territorial drug expenditures show a dramatic decrease compared to the previous period. CONCLUSIONS: Our analysis show that there is still room for better rationalise healthcare expenditure, however the greater empowerment of the regions and the policies implemented in recent years have improved the economic performance of the Italian healthcare expenditure.