Institutions, cost-effectiveness analysis and healthcare rationing: The example of healthcare coverage in the english national health service

Agencies designed to inform the distribution of public resources between competing healthcare programmes are now commonplace across the developed world. While cost-effectiveness analysis (CEA) has become integral to prescriptions for such decisions, its influence in practice remains modest especially at local decision-making levels. Explanations focus on evidence and interests and therefore overlook the role played by institutions in determining the use of CEA. Case studies from the English National Health Service indicate that institutions are critical to understanding the technology coverage function and the role of evidence, analysis and deliberation in this.