A more in depth analysis of volume activity suggests that health spending differentials between Italy and other European countries arise from differences in the delivery of non-acute health services (Sassi, 2013). While differences in the volume of hospital services appeared limited between countries, the analy sis strongly points to the fact that community, long term care and preventive services are underdeveloped in Italy compared to other European countries. As demonstrated by Figure 1.5, Italy had one of the lowest number of healthy life years at age 65 in 2011, with nearly seven years free of disability for women and about eight for men (compared to 9.5 years for women and men on average across OECD countries).