The 20th century witnessed a globaltransformation in human health. Chile's experienceillustrates the magnitude of this transformation. By themid-1990s Chile's per capita income had reached aboutUS$4,000 (adjusted for purchasing power), and Chilean womenhad achieved a life expectancy of 79 years. A century ago,in 1900, today's high-income countries also had incomelevels around $4,000-and, therefore, had resourcessufficient to provide their populations with adequate food,water, shelter, and sanitation. Yet, for them, female lifeexpectancy at the time was perhaps 30 years less than it isin Chile today. An important factor has been advance inscientific knowledge and its application both in creatingpowerful interventions and in guiding behavior. Acquisitionand utilization of health research and development or itsproducts becomes, then, an essential function of acountry's health system. Much knowledge is embodied inglobal public goods: once a vaccine for hepatitis B has beendeveloped anywhere it becomes, in some sense, availableeverywhere. Although monopoly pricing made possible bypatents may slow the diffusion of some innovations, thetemporary nature of patent-induced monopoly pricing limitsthis effect. But an innovation's being cheap, powerful,and globally available in no way entails its global use.There indeed appears to be enormous variation in the rate atwhich different countries make use of knowledge and productsthat are globally available. This discussion paper presentsknowledge as an important function of national healthsystems. The paper uses the term acquisition rather thanpurchasing for the most part because of its more generalconnotation. Most of the issues such as agency roles andorganization that are important for resource allocation andpurchasing in general are likewise important with respect toresearch and development.
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