This issue of Health Economics, Policy and Law arrives at a moment when health systems across Europe are being asked to reconcile competing imperatives that resist easy resolution: making better decisions about what to fund, how to regulate innovation, and whom to prioritise, while doing so under conditions of institutional flux.Across pharmaceuticals, medical devices, digital services, and broader public health obligations, the papers published in this issue show that the central question is no longer whether health systems should be evidence-based, but rather what kinds of evidence, values, institutions, and legal frameworks are needed to govern fairly under conditions of uncertainty, scarcity, and technological change.They map an emerging policy landscape in which effectiveness, price, evidence generation, procedural authority, and equity are increasingly intertwined and in which the governance of health technology is becoming a European question as much as a national one.Health system design and rationing now extend beyond the traditional moment of market entry.This is true across domains.In pharmaceuticals, decisions about coverage and reimbursement are not just isolated technical exercises, but instead, they are iterative and normatively loaded.In medical devices, initial approval generates only limited and often short-term evidence, leaving the risks and benefits of sustained real-world use inadequately determined.In digital health, implementation depends on institutional, professional, and patient alignment that no regulatory decision can easily mandate.What unites these domains is the shared inadequacy that governance architectures designed around market entry are being asked to manage the full lifecycle of technologies that evolve in use, generate new evidence over time, and produce outcomes (i.e., clinical, organisational, and distributional) that only become visible later.The old model of one-off assessment is giving way to continuous governance, but the institutional infrastructure to support that shift remains incomplete.The legal analysis by Domenici et al. (2026) is especially important in this regard.Their comparative study of France, Germany, and England argues that effectiveness should be understood as a general legal principle of public healthcare systems, with both substantive and formal dimensions.Substantively, effectiveness concerns the capacity of an intervention to generate clinical benefit while accounting for risk; formally, it depends on the delegated authority of Health Technology Assessment (HTA) bodies and related agencies to specify evidentiary standards and issue binding guidance.The paper is important because it reframes effectiveness as a foundational
Friebel et al. (Wed,) studied this question.