In recent years the focus for the evaluation of health services has sh
ifted from unnecessary treatment-specifically, unnecessary surgery-to
appropriateness research. This new emphasis constitutes a shift in the
burden of proof, indicating increased attention to the evidentiary ba
sis of medical and surgical practice. The evaluation of the appropriat
eness of health services is also seen as integral to the reforming dri
ve to contain health care costs and improve quality. Because of its pi
votal role as a criterion in health care decision-making, the concept
of appropriateness requires clarification. Three sources of value are
defined that give meaning to ''appropriateness'' in patient care: the
clinical point of view, the point of view of the individual patient, a
nd the societal point of view. This framework is also used to shed lig
ht on the issue of medical futility.