Editorial: Health care economics in neurosurgery: there is no turning back

Although we as physicians have developed knowledge and expertise in reporting and analyzing clinical outcome, costs remain for most neurosurgeons a no-man's-land, or perhaps a lonely-man's-land, with very few engaged in health economics. This will need to change as health care delivery and financing in the US undergoes a period of seismic transformation. These changes carry dramatic implications for referral patterns, hospital-physician partnerships, configuration of health care networks, patient access to the full range of procedures and technologies, and the training environment of future neurosurgeons. lthough growth in US health care spending remained stable in 2013 (approximately 4%), health care continues to command a greater annual share of gross domestic product. Given that 11 million Americans are projected to gain health insurance coverage in 2014, expected growth in spending is 6.1% (http://www.cms.gov/ research-statistics-data-and-systems/statistics-trendsand-reports/nationalhealthexpenddata/downloads/ proj2012.pdf). These massive structural pressures will force a stronger accounting of health care costs and demand more efficient neurosurgical practice in a resourceconstrained environment.