Identifying health system value dimensions: more than health gain?

Publicly funded health system reforms increasingly require the evaluation of competing programs. However, programs are made of multidimensional attributes of value (where value refers to latent expectations of health system improvement). This paper identifies the design, implementation and validation of a methodology to elicit health system values to guide health care priority setting. The exercise suggests that the proposed mixed methods methodology is suitable for eliciting and validating health system values, and its findings show that pursuing health gain alone does not fully capture the dimensions of health system value. More specifically, we identify a list of health system values (elicited by both potential and actual users) and classify them in terms of process related values (e.g., shorter waiting lists, greater choice etc) and improvements in health system equity in addition to value derived from health gain.