This chapter explores the issues that surround the choices that must be made between evidence-based medicine (EBM) and cost-effectiveness based medical decision-making (CEM). In making a choice between CEM and EBM the perspective of the decision-maker becomes important. It is likely that those individuals concerned with the financing of health care will be attracted to cost-benefit arguments while the medical profession will be attracted to EBM. If the allocation of resources is to consider individuals’ benefit in health care, then some expansion of the concepts of both cost and benefit is required. However, the largest task is to establish the purpose of health care systems. Ultimately, the use of competitive methods such as internal markets in allocating health care resources may lead to the adoption of utilitarian resource allocation if it remains unfettered. The easiest way in which the problems associated with markets may be solved is by the involvement of the public in decision-making.