The national government defines the benefits package, or LEAs, at the annual Standing Conference on Relations between the State, the Regions and the Autonomous Provinces. Decisions are based mainly on clinical effectiveness and appropriateness rather than cost-effectiveness. At the regional level, some governments have established agencies to evaluate and monitor local health care quality and provide technical comparative effectiveness assessments and scientific support to regional health departments (see below). Regional governments underwrite annual “Pacts for Health” that link additional resources to the achievement of health care planning and expenditure goals