Rome, December 11 - Italian President Giorgio Napolitano said Tuesday that the well-off should pay more for health care in order to sustain Italy's struggling national health service (SSN). The SSN needed to be renewed ''though careful intervention'' but ''those who can make a higher contribution'' should pay more, taking into account ''their effective income capacity'', said the head of state. Italy's national health service came under the axe in the recent government spending review, sparking debate about its future. Napolitano said the SSN - created in its present form in 1978 - is ''a mark of civilisation'' that makes Italy ''one of the most advanced countries'' in the sector. He therefore urged reformers to pursue ''innovation and rationalisation'' of the system without detracting from the logic that inspired it.