4. DiscussionPriority setting proce

4. DiscussionPriority setting processes for the subsidy of healthtechnologies in Australia incorporate, either explicitly orimplicitly, a range of social values related to both theprocess and the content of decision-making. As antici-pated by Clark and Weale [20], our analysis finds overlapbetween the values included in their framework. Trans-parency is closely linked to accountability; a desire toachieve both is apparent in Australian health technologypriority-setting processes and decision-making. However,the commercial-in-confidence nature of assessments maylimit the capacity of the system to achieve complete trans-parency of the underlying reasons for decisions. Comparedto a previous study published in 2006 in which Mitton andcolleagues evaluated Australian PBAC processes againstthe Accountability for Reasonableness Framework [3,28],the transparency and accountability of PBAC processes hasimproved. However, the value of participation was notexplicitly explored in this previous study and appears topresent an opportunity for further enhancement of pro-cesses in Australia. Australian HTA processes seem to strivefor a balance between inclusiveness and effectiveness indecision-making; both important considerations. How-ever, whilst stakeholder engagement is strong, proactiveparticipation by the public is less apparent. Participation indecision-making could arguably be improved if a patientand public engagement policy were to be formulated acrossall HTA processes in Australia, as well as more widespreadchanges across HTA processes to assess community valuesaround technology assessment using approaches such asthe Citizens’ Jury that have been implemented with somesuccess in other jurisdictions [75].