ABSTRACT
This chapter analyses some of the important challenges facing health systems. After a brief review of confusing terminology, Stewart Mercer describes the epidemiology of multimorbidity. It considers the challenge of multimorbidity for health services; Ken Mclean considers how to assess the quality of generalist clinical care. The chapter also considers reasons for the imbalance between specialist and generalist care, how sufficient numbers of generalists can be maintained and the continuing challenge of health inequalities as a result of the Inverse Care Law. Multimorbidity is not a new problem to be dealt with in old ways but a huge challenge to the nature, organisation, resourcing and culture of health care. The most common comorbidity in older people is hypertension so that only one other condition is required to meet the definition of multimorbidity. This case definition offers little new challenge to clinicians or to services.
