A look at the international medical literature shows the importance of waste and inappropriateness defined as futile and inadequate services that may not be beneficial for patients but rather expose them to additional risks, to over-diagnosis and over-treatments. A 2010 WHO report estimates that the amount of services providing no benefit to patients accounts for approximately 20-40% of healthcare spending.
The main drivers of the inappropriateness and waste in clinical practice are the economic incentives, the uncertainty that characterizes the medical practice, conflicts of interests and defensive medicine. Although Italy ranked below the OECD (Organisation for Economic Co-operation and Development) average in terms of health spending per capita in 2011, this evidence does not mean that the Italian Health System is characterized by an underuse of medical services or by a low level of prescriptions inappropriateness.

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