Insularity, character traits and local political interference: the pivotal players of the Sardinia regional health service's progressive decline.

Sardinia is a peculiar Italian autonomous region characterized by a small population, a unique genetic heritage and challenges related to socioeconomic isolation due to insularity. Despite the significant financial resources allocated annually for the Regional Health Service its performance is slowly getting worse. As autonomous insular region, Sardegna represents an ideal "experimental laboratory" for identify the major determinants of this failure. The character traits of Sardinian people, strongly influenced by centuries of colonization and socio-political adaptation, the challenges of insularity, and the health policies adopted at regional and local level, collectively contribute to the progressive failure of the Regional Health Service. The aim of this contribution is to analyze the effects of these factors on the Regional Health Service's performance and to identify corrective actions to reverse the negative trend.