OBJECTIVES: In economic evaluations of health care interventions, outcomes are often expressed in terms of Quality-Adjusted Life-Years (QALYs). Deriving QALY weights, operationalized as preferences for health states, requires important normative choices. One important choice is the question whose preferences we wish to capture. Currently, preferences are commonly derived from the general public, rather than from actual patients. This choice, which has large consequences on final outcomes of economic evaluations, is increasingly topic of debate.  In the current study, arguments for and against public preferences are discussed and alternatives are suggested. METHODS: We highlight and critically assess the different viewpoints put forward in the health economic literature regarding the public and patient perspective. Patient preferences are considered to reflect true patient experiences, but are troublesome because preference values elicited from patients are ‘unusually’ high due to adaptation. Public preferences are argued to be less sensitive to adaptation, but are troublesome because they do not adequately forecast experience. RESULTS: The arguments put forward in the literature do not provide straightforward support for assessing outcomes QALY weights derived the general public. The exclusion of patient values in public decision-making is not sufficiently argued. With patient preferences life saving interventions are likely to become more cost-effective. CONCLUSIONS: Arguments for and against both positions represent different normative positions regarding the appropriate measure of outcome in health care decisions. To date, the debate seems to have focused on the question which of the two would be most appropriate. However, it seems unclear why such a dichotomy would be necessary or, in fact, useful. Both public and patient preferences appear to be important sources of information for the allocation of health care resources in society. Perhaps the question should be how to intelligently combine the two.