As part of the William Davidson Institute’s celebration of 25 years of market-based solutions, this
paper reviews the changes that have taken place in health care delivery in low- and middle- income
countries since 1992, highlighting the role of the private sector. This is an enormous task and in the
present paper we do not attempt a comprehensive overview. Instead, we will begin with a look at
changes in causes of death and follow that with a more in-depth view of a few areas that appear
likely to take on more prominence (primary care, surgical care, care for the elderly and mental health)
and/or change health care delivery significantly in the coming years (medical device innovations
and telemedicine). We will review both literature and data, but also discuss some examples of work
in the field. The goal is to describe what is happening and, to an extent, what the implications are
for the future. Much of the discussion about the future is based on an expectation of where money
is likely to be spent in LMICs by both the global development community and private individuals
(or companies). We also look at models that have been successful and are thus likely to become
more prevalent in the future. We will not be addressing arguments about where the greatest social
impact is likely to take place except to the extent that affects the current and future state of health
care delivery. This paper will serve as a primer for anyone interested in understanding health care
delivery in emerging markets. Such an understanding will benefit efforts to a) anticipate what
changes can be expected in the future and b) determine the most productive future investments.
