The role of evidence in health policy making: a normative perspective.

Assessment of evidence is becoming a central part of health policy decisions--not least in limit setting decisions. Limit-setting decisions can be defined as the withholding of potentially beneficial health care. This article seeks to explore the value choices related to the use of evidence in limit-setting decisions at the political level. To better specify the important but restricted role of evidence in such decisions, the value choices of relevance are discussed explicitly. Four criteria are often considered when setting limits: 1. The severity of disease if untreated or treated by standard care 2. The effectiveness of the new technology 3. The cost-effectiveness of the new technology 4. The quality of evidence on (1)-(3) The production and assessment of evidence is important for each criterion, but several points are identified where the practice of evidence-based medicine could be further developed to capture a broader spectrum of ethical and political concerns that such decisions naturally evoke among citizens.