[Who decides what appropriate care is, and how? Time for societal considerations and explicit choices in the Netherlands].

Appropriate care in the Netherlands is defined as care that is value-based, demonstrably effective and organised around patients. Yet within the 'open system", covering about 90% of insured care, it often remains unclear which interventions are truly appropriate. Unlike the closed system for medicines, no formal framework exists to systematically weigh scientific evidence and societal values or to translate these into transparent, explicit decisions. As a result, new treatments frequently enter practice almost automatically once they become common within a professional group and appear scientifically sound, rather than through deliberate and accountable choice. Drawing on examples such as Zinnige Zorg and the Round Table on Diabetes Care, we argue for a clear and transparent framework to support explicit choices on appropriate care. Evidence-Informed Deliberative Processes (EDPs), involving patients, professionals, insurers and independent experts, offer a promising model. Such frameworks are essential to ensure that decisions on appropriate care are evidence-based, societally legitimate and sustainable.