The aim of this study is to address the challenges of using cost-effectiveness analysis (CEA) by decision-makers in rationalizing health care public spending. Firstly, it presents a brief literature review on the necessity of using cost-effectiveness analysis. Also, the paper focuses on ways of measuring health outcomes and costs, analyzing the evolution of public expenditures on health care after 1990 in Romania, in comparison with those of the European Member States, in monetary terms, but also on the basis of some internal efficiency indicators. Even if there are many limitations concerning the implementation of this analysis and many studies labeled as CEAs in the health-care literature often offer only partial program evaluation, basing only on resource costs, CEA is helpful and necessary in setting priorities when choices must be made in the face of limited resources.