Universally, health care systems are currently undergoing tremendous change. It is not sufficient to demonstrate that specific medical interventions and services are effective, as third party payers have become increasingly interested in financial outcomes. Managed care has accelerated this movement and rheumatology is facing new challenges to position itself in a changing health care environment. Studies dealing with the economic burden of musculoskeletal diseases and the economic evaluation of particular services and interventions are reviewed. As the health care system shifts toward managed care, rheumatology is facing tremendous challenges to position itself in new markets.