This report reviews the quality of health care in Italy, seeks to highlight best practices, and provides a series of targeted assessments and recommendations for further improvements to quality of care. Italy’s indicators of health system outcomes, quality and efficiency are uniformly impressive. Life expectancy is the fifth highest in the OECD. Avoidable admission rates are amongst the very best in the OECD, and case-fatality after stroke or heart attack are also well below OECD averages. These figures, however, mask profound regional differences. Five times as many children in Sicily are admitted to hospital with an asthma attack than in Tuscany, for example. Despite this, quality improvement and service redesign have taken a back-seat as the fiscal crisis has hit. Fiscal consolidation has become an over-riding priority, even as health needs rapidly evolve. Italy must urgently prioritise quality of its health care services alongside fiscal sustainability. Regional differences must be lessened, in part by giving central authorities a greater role in supporting regional monitoring of local performance. Proactive, coordinated care for people with complex needs must be delivered by a strengthened primary care sector. Fundamental to each of these steps will be ensuring that the knowledge and skills of the health care workforce are best matched to needs.