Who Should Define Value in Spine Care?

Ideally, each patient should be provided with accurate information on outcome and cost and select care based on the best value and personal care preferences. Unfortunately, useful information on outcome is often absent or equivocal, and information on cost is obscured by the design of our health care system. Numerous efforts are underway to better empower patients in decision-making and support patient-centered research. Comparative effectiveness studies and patient registries will generate new information and may help to define value. Techniques for measurement of cost will need to be refined and more commonly used. While these efforts are progressing, medical societies, the government, and insurers have developed standardized methods to collect and analyze the current literature and make recommendations for care they believe valuable and appropriate. Clinical care guidelines, health technology assessments, meta-analysis, and appropriateness criteria are some of the structured methods for assessing the current evidence. These clinical care recommendations are useful but are incomplete and inadequate in defining value because of the absence of information on cost and the limited information on outcomes.