"Adjusting to Advances in Knowledge and Technology"

Growth in the available knowledge or advances in technology – such as new drugs or diagnostic equipment – can substantially increase the capacity to solve health problems, and thereby improve the performance of a health care system. New knowledge is also a challenge to each country’s existing input balance, as relative prices change and the efficient mix of resources alters. In the past few decades, revolutionary advances in medicine and technology have shifted the boundaries between hospitals, primary health care, and community care. Corresponding resource shifts in health systems have been much slower to emerge.

All countries – rich as well as poor – need to find and maintain a reasonable balance between inputs. The choices involved in finding this balance, however, vary depending on the amount of total resources available. In a poor country, the possibilities of investing in modern medical technologies or paying for modern medicines are very limited. Moving from the use of essential drugs to new and expensive drugs for cardiovascular diseases would mean an enormous opportunity loss in terms of health outcome for a poor country. This difference in opportunities across countries also has an impact on the optimal balance between resources.

Some input prices are determined locally; others are set in international markets. In most countries, prices for human resources (incomes for physicians, nurses and other health care personnel) are determined nationally, and the general income level for each country or region will be an important determinant. Prices for such items as patented drugs and medical equipment, on the other hand, are determined in a global market. Although differences in income levels across countries will induce manufacturers and distributors of medicines and equipment to differentiate prices somewhat, stewards of individual country health systems are far less able to influence these prices than the prices of human resources. International stewardship is needed to represent the interests of consumers in low income countries that face heavy burdens of infectious and parasitic diseases.

Extract from: World Health Organisation, The World Health Report 2000. Health Systems: Improving Performance. Chapter 4, "What Resources are Needed", pp. 81f., http://www.who.int/whr/. Reproduced with the kind permission of WHO. ©World Health Organization 2000.