Universal healthcare coverage (UHC) is now firmly on the global health agenda. In December 2012, the UN Assembly voted for UHC, with wide-ranging support including from the US and UK governments, and calling on countries to provide “access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost” [1]. The Washington Post ran the news with the headline ‘Obamacare Everywhere’ [2], drawing parallels with the US debate on expanding insurance to cover all Americans (although recent developments may curb the political commitment to UHC in the USA). Yet, given scarce resources, UHC cannot feasibly provide every beneficial health service to those in need. So, a critical first step to delivering on these aspirations is deciding which services and policies to prioritize and make available and at what cost, if any, to beneficiaries. As UHC is defined as ‘a comprehensive range of key services…well aligned with other social goals’ [3], the question naturally arises: ‘how comprehensive is comprehensive’? The Institute of Medicine (IOM) Committee on designing essential health benefits [4], reporting around the same time as the UN resolution, exemplifies how balancing “the tensions between comprehensiveness and affordability” is faced not only by poorer countries but also by the world's biggest spender on health, the USA. Far from making clear recommendations on what is in and what is out, the IOM Committee limited itself to general rules and principles for guiding others with the tough task of making coverage decisions. One tool not mentioned by the IOM, and which can help policy-makers make and defend such hard choices for including or rejecting new or (less often) excluding existing interventions, is what in the USA is known as comparative effectiveness research (CER) and overseas as health technology assessment (HTA), a more pragmatic version of evidence-based medicine, where budgets and cost–effectiveness analyses (CEA) matter at least as much as comparative clinical effectiveness [5]. As UHC is necessarily country-specific, since the demography, epidemiology, spending requirements and prices or costs of products and interventions are different for every country, CER or HTA is also heavily context specific. So, it makes sense perhaps to discuss here how other countries around the world are setting out to attain or sustain UHC, whether they use CER as a means to such an ambitious end, and, if so, in what way. I use the terms CER and HTA interchangeably while being fully aware of the strange prejudice against considering resource constraints in the US context, which makes the term HTA less meaningful. In that sense, the USA is a policy (and expenditure) outlier.