This chapter outlines variations for nine health care activities and procedures carried out in Italy for the timeframe 2007-11. During the study period, national and median provincial rates declined for almost all procedures, except for caesarean rates and knee replacements. The coefficient of variation remained generally stable, with the exception of a decrease in hospital medical admissions and increase in catheterisation and knee arthroscopy. However, the gap between the highest and lowest rates, except for hospital medical admissions, generally widened, showing that extreme values are still present and shall raise the concern of policy makers. The increased implementation of programmes on quality monitoring (National Outcomes Programme, Griglia LEA) and efficiency (Recovery Plans) may have contributed to the steady reduction in overall rates, such as the declining caesarean section rates observed in southern regions in 2012. However, targeted action is still needed to reduce the high level of variation found to persist across the country.