Social values and health priority setting in England: “values” based decision making

The purpose of this paper is to provide an overview of the organisational and procedural arrangements for priority setting in England and Wales. It describes the role of social values in the decision-making process.The processes and content of decisions made by the National Institute for Health and Clinical Excellence are analysed using the framework developed by Clark and Weale for identifying social values in health priority-setting.While countries are seeking to achieve similar outcomes from their health prioritisation processes, each country has established different systems that reflect the social and legal framework underpinning their health systems. England is somewhat unique in being explicit about assessing "value for money" and using formal cost-effectiveness in developing policy.Many countries are now considering the use of formal health economic methodologies to assess the value and prioritise health care interventions. However there is increasing recognition of the importance of values other than efficiency (cost effectiveness) in making acceptable decisions. This is manifest in the range of potential new approaches being developed including multiple criteria decision analysis.