The "Bundesausschuss der Aerzte und Krankenkassen" (hereafter referred to as the "Bundesausschuss") is one of Germany's self-governing bodies in ambulatory health care. This Federal Standing Committee of Physicians and Sickness Funds has the mandate, among others, to issue directives for the ambulatory health care provided by 110,000 physicians to the approximately 70 million citizens of Germany. The Bundesausschuss' directives are legally binding and must be followed by both the physicians who provide ambulatory medical services and the sickness funds who insure these services. Although elements of evidence-based medicine were first introduced in 1990, health technology assessment (HTA) was not systematically integrated into the decision making process of the working group for medical and surgical procedures until 1998. The HTA reports of the Bundesausschuss take account of the status of the technology in other health care systems (public systems in particular) and of statements by the scientific community and interested parties, such as patient groups, and review the evidence currently available (in primary studies, systematic reviews, other assessments, etc.). These reports are prepared by representatives of the physicians and the sickness funds, in close collaboration, whenever possible, with academic experts in health technology assessment. The reports serve as a basis for the decisions made by the Bundesausschuss, which ensures their impact, and are published on the Internet at http://www.kbv.de/hta. The Bundesausschuss reports also reflect the deliberation process for each technology, in the context of the legal environment. They also explain how a decision was reached. The shortcomings of HTA process are the time and financial resources required to conduct these assessment. The advantages include the increased transparency of the decision-making process, for both the German "social" court system and for the insured. Further developments will be directed by the future framing of the legal environment by the ministry of health. A similar decision-making body has recently been installed for the hospital sector and both committees will be co-ordinated by a board, which will organize the deliberation process. It will be important to further encourage and integrate the use of evidence in the decision-making processes of these statutory bodies.