As the rate of medical innovation accelerates, competing demands from various stakeholders put unprecedented pressure on health systems to deliver high-value medical care. Most health systems claim to link coverage decisions to the value for money afforded by specific treatments, but their approaches to valuation differ. Many countries, such as the United Kingdom, have historically relied on traditional cost-effectiveness analysis using the cost-per-QALY metric to guide coverage decisions. Other countries like France and Germany never adopted the uncertain place of cost-utility analysis in the decision processes", relying instead on disease-specific metrics. The large majority of payers in the pluralistic US health care market deny explicit consideration of cost effectiveness in coverage decisions, and US law forbids its use as part of the Affordable Care Act. Instead, public and private payers in the United States increasingly push financial risk onto health care providers thereby, in a sense, decentralizing the assessment of value. Health economists from the United Kingdom, the United States, and France will provide reflective views on how valuation of medical technologies has changed across time and will discuss the methodological, societal, and political forces that shaped their evolution. The speakers will also consider what the future holds for valuation in health.