Background <p>There is a strong emphasis globally that health policy and practice can be improved by leveraging best available evidence in decision-making processes. The dynamic political context of policy means, however, that decision-making processes are highly complex. A growing field of inquiry examines how the evidence-informed approach impacts on and interacts with real-world policy development. Despite the growing recognition of the complexity of health policy development little is known about policy narratives underpinning evidence-informed decision-making. Analysis of policy narratives over time can reveal how recognition of policy problems and their corresponding solutions emerge and shift through a contestation of different ideas and interests and how they legitimise different political courses of action. The aim of this study is to explore policy narratives underpinning evidence-informed decision-making within Swedish healthcare, tracing their formulation and development from 1992 to 2024.</p> Methods <p>The study is based on a textual analysis of Swedish government documents published 1992–2024. Drawing on theories of policy narratives, a thematic content analysis of 132 Swedish government-issued documents during this period was conducted.</p> Results <p>Four episodes with a dominant narrative in each emerged from the analysis. They differ in ideas connected to policy problems and solutions in healthcare and evidence-informed decision-making. Besides ideas on the substance of the policy solutions, the ideas include different assumptions about problems they are solving, how healthcare actors are connected to problems and solutions, values that motivate the solutions, and assumptions about mechanisms that will promote sound decision-making and resource use in healthcare. These four policy narratives include one of efficiency, provision of information, and deliberation; one of equality, data, and standardisation; one of integration, synthesis of perspectives, and collaboration; and one of responsiveness and the local context of decisions.</p> Conclusion <p>The study offers insights into the governance of evidence-informed decision-making in healthcare. The findings contribute to a broader understanding of implications of the evidence-informed approach on healthcare policy, and how healthcare policy is shaped by competing ideas, values and assumptions. They also contribute to the theoretical debate on policy narratives, and discursive practice in general in healthcare governance.</p>