There are two predominant forms of decision-making frameworks currently being applied in the present health care environment. These are evidence-based medicine (EBM) and cost-effectiveness based medical decision-making (CEM). EBM seeks to maximize benefit to an individual patient, or at least minimize the harm caused by medical treatment. In contrast, CEM seeks to examine the relative values in monetary terms, of interventions and to use this information to provide maximum benefit to a population under conditions where resources are scarce. Both of these techniques have tendencies to produce positivism-based decision-making, which has a technocratic bias. EBM and CEM are also in conflict. The application of EBM may increase the costs of medical practice. Therefore, a choice has to be made about which system af decision-making to apply. Both cost-effectiveness analysis and evidence will not solve the problems of rationing and resource allocation, as in themselves they may exacerbate the problem. Instead it is requisite that rationing is determined by knowing when to apply evidene-based rules and when to apply cost-based rules. If the allocation of resources is to consider individuals' benefit in health care, then some expansions of the concepts of both cost and benefit is required. However the largest task is to establish the purpose of health care systems.