OBJECTIVES:  Value-based healthcare (VBHC) is a patient-centric framework to improve performance in healthcare systems. Value is commonly defined as the health outcomes benefiting the patient over cost. The field of orthopaedics is well placed to introduce VBHC principles into practice given the high volume of discrete conditions and procedures. The aim of this study was to assess the alignment of VBHC in orthopaedics globally. METHODS: Data from the Economist Intelligence Unit (EIU) was used. EIU researched, assessed and scored 25 countries across a set of 17 original qualitative indicators (scored on an integer basis). These span four domains: enabling context, policy and institutions for value in healthcare; measuring outcomes and costs; integrated and patient focused care; and outcome based payment approached. RESULTS:  (1) Most developed countries have moderate alignment with VBHC. Only Sweden emerges with very high alignment and the UK is the only country with high alignment. (2) Whilst India and China generally have similar results, they diverge strongly on health coverage: just 18% of India’s population covered by some form of health insurance while in China more than 95% of the population is covered by public health insurance. (3) Strong policy support is generally found in wealthier countries, which helps the transition towards VBHC. (4) The advantage of bundled payments for co-ordinating care and focusing on the patient is increasingly being recognised. In six of the 25 countries assessed, one or more payers are implementing bundled payments. (5) Moving from fragmented single-provider-based care to co-ordinated, team-based care remains challenging. Many countries lack coordinated care pathways, which are not nationally standardised. CONCLUSIONS: Some countries are coming closer to aligning their health systems to the VBHC model, but the majority are still in the early stages. Often lower income countries have other priorities such as increasing access to basic health service and improving quality.