We describe in detail a twofold proposal for the creation, organization and sequential development of two bodies responsible for evaluating the efficiency of health technologies and policies in Spain and its possible design. It would constitute a key element in the process of re-organising the National Health System. The first, which could be adopted immediately, would be called the Office for the Evaluation of the Efficiency of Medicines, would be attached to the Spanish Agency for Medicines and Medical Devices as a functionally independent body and limited to evaluating the efficiency of medicines. The second, the National Health Evaluation Commission, in the form of an independent administrative body, would evaluate health technologies and possibly public health policies. Functional independence, adequate resources and anchoring in the values of good governance are the defining characteristics of this dual proposal.