Introduction

This chapter examines the challenges inherent in assessing how health systems perform in response to chronic diseases. These are diseases that persist over an extended time and require a complex response involving coordinated inputs from a wide range of health professionals, access to essential medicines and (where appropriate) monitoring equipment. Ideally this is embedded within a system that promotes patient empowerment. There are many chronic diseases but in this chapter we draw extensively on experience with diabetes. The reasons for this are three-fold. First, diabetes was the first example of an acute disease that was transformed into a chronic disorder by the introduction of effective treatment. Second, it exemplifies the complex nature of chronic disease as its complications affect many different bodily systems and call upon the expertise of a wide range of specialists. Third, it provides a lens through which to view the performance of the overall health system.

Health system performance is the focus of the chapter and this volume. However, before looking specifically at performance it is necessary to understand the specificities of chronic diseases, many of which pose substantial challenges for performance measurement. It may also be helpful to reflect on the rapidly increasing contribution of chronic diseases to the overall burden of disease, a development that has important consequences for the assessment of health system performance more generally.