Since the establishment of the Christian Church, secular and religious powers in Italy have often experienced difficult coexistence. A paradigmatic case of fractious institutional development has been in the provision of health services. This study explores the roles played by the Church and state in Italy in the creation and historical development of the modern healthcare system. First, it demonstrates that the early Church played a critical role in the development of Italian and other healthcare systems in Europe. Religious hospitals remained the backbone of Italian healthcare provision from the Christian-era Roman Empire until the end of the medieval period. Gradually, from the 14th century onwards, a parallel state hospital system developed. Turning to Italy post-Unification, the paper demonstrates that state-run hospitals continued to expand. Over time, a state-led project to assert a national health system led to the introduction of laws and regulations favouring public hospitals at the expense of religious hospitals as well as other privately run institutions. The fascist period from 1920 to 1945, marked by an implicit alliance between state and religious authorities, represented a brief but notable exception to this trend. Today, the foundational trinomial concepts of early healthcare – charity, private initiative, and religion – have been displaced by the principles of welfare, public prerogative, and secularism. The paper’s findings are expected to shed light on the distinctive role of the church in shaping Italy’s healthcare system.