Better value healthcare--the 21st century agenda.

Health services are faced with increasing cost pressure, and cost-effectiveness is playing a growing role in decision-making in health care. The three elements of decision-making are the evidence available, the values of the population served, and the other needs of the population. There are different types of values: those of patients, clinicians, health service managers, payers of healthcare, and industry. The sharp distinction between traditional functions in healthcare, such as "allocative efficiency" and "technical efficiency", is increasingly being broken down. The effect of this new approach is the rise of programme budgeting, with healthcare resources being allocated to different programmes of care (for example, mental health programmes), making the consequences of moving resources much clearer. Best current evidence about effectiveness and cost-effectiveness is of vital importance in clarifying the opportunities that face people who pay for or manage healthcare.