After briefly tracing the principal steps of citizenship concept’s development, this article illustrates the pre-eminence of social participation as a citizenship "practice". Then, it analyses either the potentialities and limits of deliberative approaches, set in to promote new forms of health citizenship, or the critical aspects of the relation between the health system and the users that can erode the exercise of citizens’ social rights. In relation to the critical aspects emerged from our review, the representative deficit, the influence of participatory action on decision makers and the little interest in evaluating participation effectiveness are accurately analysed. In conclusion, the main challenges of citizenship in the health system area are highlighted.
Keywords: Cittadinanza, partecipazione, sistemi sanitari, approcci deliberativi, valutazione della partecipazione, rappresentatività