This paper analyses the regulation of standard costs in Legislative Decree No. 68/2011.  It begins with an examination of some concepts that are often confused in the scientific and political debate, such as federalism, fiscal federalism and health federalism (see first section). Then, in the second section, it investigates the main differences between the regional and federal State and verifies whether references to federalism are made in the Italian Constitution under the new Title V. The third section focuses on the notion of fiscal federalism in Law No. 42/2009 and in Legislative Decree No. 68/2011 regarding the standard requirements of Municipalities, Metropolitan Cities and Provinces. The fourth section examines the close relationship between fiscal federalism and health federalism in Legislative Decrees No. 229/1999 and No. 56/2000 while also trying to understand the historical context in which the two concepts were initially envisaged. Finally, with the firm belief that federalism and health protection must go hand in hand, especially after the constitutional reform of 2001, the fifth section examines the procedure laid down by Legislative Decree No. 68/2011 in order to identify the benchmark Regions and consequent standard costs that will be applied from 2013 on in all the other Italian Regions. In the conclusion of this paper, some critical points, such as the age factor, the only criteria of calculation employed by Legislative Decree No. 68/2011, are highlighted, leading us to propose some minor amendments to the text of the Decree
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