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In the last decades, paternalistic medicine based on the principles of “science and conscience”, has been definitively replaced by evidence-based medicine, in order to ensure that only interventions with strong evidence of clinical efficacy/utility will be used. Evidence-based medicine, however, has two main limitations. The first one is that it fits with difficulty to the individual pa-tient. To overcome this limitation, precision medicine has been founded. The second and main limitation is that evidence-based medicine and the related concept of clinical appropriateness do not consider the costs of health services. Clinical appropriate-ness should therefore be closely associated with organizing appropriateness, to give absolute relevance to both the concepts of risk/effectiveness and cost/effectiveness of the healthcare. Accordingly, every intervention aimed at improving individual and public health should include evidence-based decision making, quality improvement and cost reduction. These features are all nec-essary but not sufficient. A new approach is emerging, called value-based healthcare, which aims to privilege activities capable of generating value, in a new model of healtcare in which interventions are reimbursed on the base of the results obtained on the whole community health.

L'assistenza sanitaria basata sul valore