This paper discusses the problematic and sometimes implicit nature of some 
central notions and criteria used in debates about inclusion (or exclusion) of 
health care services in the health care benefit package. An analysis of 
discussions about four health care services--lungtransplantation, statins, 
(sildenafil (viagra) and rivastigmine--illustrates a case-by-case approach and 
inconsistent use of criteria, which present a challenge to develop a 
decision-making procedure in which important criteria or central notions can be 
discussed explicitly.