Recent reforms in Italy, and in particular, the recently created National Agency for Regional Healthcare (AGENAS), are instructive here. Health system managers, whether at national, state or institutional level, are rarely able to point to projects that have used data to identify areas of excellence or weakness, or that have been used as a basis for quality improvement work. Infrequent comparison and benchmarking of results is a linked problem, since even simple things such as waiting times are not measured consistently across Mexico’s sub-systems.