OBJECTIVES: To explore the ways in which hospital payments can be used to encourage cost-effective use of health technology. METHODS: A survey of the developers of hospital payment systems was conducted in 14 jurisdictions in order to ascertain if and how existing payment systems facilitate the adoption of new technologies, whether evidence of value (eg therapeutic benefit, cost-effectiveness) is considered when determining codes/ tariffs, and in what ways payment systems could be adjusted to link payment levels more closely to evidence on value for money. RESULTS: Around 50% of the jurisdictions had developed their own payment classifications, as opposed to importing/adapting a system from elsewhere. A minority had created new codes/tariffs outside of a general update in response to a new technology. Three jurisdictions used evidence of value when creating new codes/tariffs, although they tended to only consider therapeutic benefit, not cost-effectiveness. The main barriers to using evidence in creating new codes/tariffs were the lack of a clear mechanism to do so, lack of standardization in the collection of hospital cost data and unclear or unavailable clinical evidence. Around 70% of jurisdictions had used special payments, outside of the standard codes/tariffs, in response to specific new technologies and 50% used evidence of value when setting payment levels. In the case of special payments, consideration of evidence of both therapeutic benefit and cost-effectiveness was more common. Overall, respondents felt that hospital payment systems had only a modest to moderate impact on the uptake of new technologies, due primarily to the time taken in establishing new codes/tariffs, or negotiating special payments. CONCLUSIONS: Hospital payment systems have the potential to encourage the cost-effective use of new health technologies. More attention, however, is needed regarding the procedures for updating codes/tariffs or negotiating special payments, and in particular the ways of considering evidence of value.