Healthcare investment is critically important for the health and well-being of the population, and different health systems are developed to meet the needs and priorities of each country. What has become clear has been that despite major advances in medicine, science and technology, there are major issues related to access and equity as well as quality and patient safety in healthcare services. The issue of patient safety was highlighted by the reports of the Institute of Medicine, USA1,2 and this had received worldwide attention. It is also an irony that despite being in an age of major advances in medicine, science and technology, with the acceptance of evidence-based medicine, so much of medicine and healthcare delivered is of little or no proven value. This poses a major challenge on health policy, and on how this can be addressed in any health reform process that focuses on improving access, equity, efficiency and effectiveness in healthcare services.