Overview

The first section of this volume is concerned with the changing context for health financing in developing and transitional countries. Two chapters address contemporary issues. The first, by Cristina Gutiérrez-Delgado and Veronica Guajardo-Barrón, describes the challenges created by the “double burden” of disease in low- and middle-income countries created by the coexistence of the persistent burden of communicable disease with emerging problems of chronic and non-communicable illness. Drawing on the Mexican experience of expanding needs for anti-retroviral therapy, renal replacement therapy, and screening and prevention of cervical cancers, they present new evidence about the burden placed by these conditions on public health budgets. They also show the potential value of adopting a risk factor approach to economic evaluation of chronic disease management, presenting estimates of the financial burden imposed by four diseases strongly associated with overweight and obesity. They conclude that strengthened stewardship functions, including generating data about disease burdens and expenditure, and greater use of explicit priority setting processes, are needed to help resolve the tensions between equity and efficiency.