Background: In South Korea, there are several issues concerning the healthcare system including a clear increasing growth rate of healthcare expenditure exceeding the economic growth rate, uncertainty of effectiveness and efficiency of new health technology, conflicts around coverage decision making, relatively higher cost and growth rate of pharmaceutical expenditure than other comparable countries, and problems out of opinion-based decision making. Objectives: To make rational decisions and to enhance acceptability of them in the healthcare system, several efforts have been made incorporating evidence into the decision-making process. Methods: At the national level, two revisions of separate laws were made in the recent two years. One is the assessment of new health technology, except drugs, in the scope of safety and effectiveness not of the efficiency based of health law. The other is health technology assessment including drugs in the scope of safety and effectiveness and efficiency, outcomes research and pragmatic clinical trials based of enhancing health industry law. In the nonprofit and public organization level, Health Insurance Review & Assessment Service (HIRA) has established evidence-based healthcare system. The Evidence Based Review Manual (EBRM) for preparing hand-outs for usual committee meetings contains the methods of proper questioning, searching, extracting data, classification of articles, and presentation. The essential databases are The Cochrane Library, MEDLINE, and EMBASE. The Evidence Report (ER) is a systematic review for more complicated issue. Results: The introduction of EBRM enhances the satisfactoriness of both the persons responsible to prepare meeting and the committee members. In various decision-making processes, EBRM has been adopted as a main method to prepare committee meeting including re-evaluation program of drugs, the special committee for review of drugs related to treatment of cancer, and Health Care Review & Assessment Committee. The need of ER has been increased rapidly in HIRA. Conclusions: As the rational solution about some issues of the healthcare system, evidence-based healthcare system has been established in Korea. These activities are in the beginning stage and no visible impact has been proven, yet. However, it is expected to give more acceptable decision making through these changes to the stakeholders in Korea.