Healthcare systems globally are fancing multiple challenges, with ageing populations, increasing chronic disease, rising multiborbidity, and innovative treatments and technologies all leading to rising costs. With finite resources, and an increasing recognition of the potential harms to patients of overdiagnosis and overtreatment, it is essential that resources are used optimally. This article explore how the value based healthcare framework can help decisions about how to allocate resources, and the importance of good evidence not only for patient treatment but the organisation of health services.