In March 2018, the Swedish Parliament decided on amendments to the Health and Medical Services Act (2017:30), introducing a new decision-making process for national highly specialised care (NHSC). Following the amendments, NHSC refers to publicly funded healthcare that must be concentrated to one or several units to maintain quality, patient safety, and knowledge development, and to ensure the efficient use of healthcare resources. The National Board of Health and Welfare (NBHW) has, on behalf of the government, developed a decision-making process for the concentration of NHSC. This process consists of eight steps, from the identification of potential care areas to follow-up and evaluation of permits. This evaluation focuses on the quality of the assessment process for five of those eight steps. The overall quality of the NHSC decision-making process is assessed as generally high, particularly in comparison to the earlier model for national specialised care (rikssjukvård), which was considered overly time-consuming and inefficient. The process is largely adhered to by stakeholders, and procedural adjustments over time suggest a capacity for institutional learning and adaptation. Despite the overall positive picture, the evaluation identifies several critical shortcomings. A key concern is the persistent difficulty in assessing the broader systemic consequences of concentrating certain types of care. There is a risk of entrenching existing patterns, as regions without significant prior engagement in certain care areas face structural barriers to entering the system. The second preparation group (B2) produces very brief and opaque justifications for its recommendations, which undermines transparency and accountability. A shortcoming of the current evaluation model is that it focuses primarily on care performance rather than broader system impacts.