Priority setting and evidence based purchasing

The purpose of this paper is to consider the role that values play in prior ity setting through the use of EBP. It is important to be clear about the r ole of values at all levels of the decision making process. At one level, s ociety as a whole has to make decisions about the kind of health provision that it wants. As is generally accepted, these priority setting questions c annot be answered by medical science alone but involve important judgements of value. However, as I hope to show values come into priority setting que stions at another level, one not often explicitly recognised in much of the literature: that of the very definition of the effectiveness of treatments . This has important consequences for patient care. If we do not recognise that the effectiveness of a treatment involve subjective elements - a patie nt's own assessment of the value of the treatment - then this could lead to the belief that we can purchase one treatment that is the most effective f or all patients. This might result in a detrimental reduction in the range of options that a patient is given with some patients not receiving the tre atment that is most effective for them.