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Until recently, the health services establishment was assumed to be a product of the social, economic, and scientific medical developments since the turn of the century. It consumed a modest and relatively constant percentage of the gross national product (GNP). It was a dependent variable. Since the 1950s, sparked by labor-management negotiations for health insurance coverage and Medicare and Medicaid, plus the dazzling high medical technology such as organ transplants, the health services establishment took off. It grew faster than the GNP and the Consumer Price Index. It competes with other priorties for goods and services. It became an independent variable having an impact on society. This essay attempts to demonstrate conceptually and empirically how and why this transformation took place.

A review of the emerging literature on cross- national health services systems and first hand studies by the author reveals that health services systems in many coun tries are converging in their egalitarian objectives, organiza tional forms, methods of paying providers, scope of services, and costs controls. Cross-nationally facilities and personnel are quite similar, indicating the importance of medical tech nology as a shaping force. Organizational forms, methods of payment, and sources of funding differ widely because these are mainly social and political expressions, but these too, are converging. Countries will continue to exhibit differences in structuring inherent in their economic and political styles, from the United States to the U.S.S.R. It is proposed that the range of difference will narrow, but not converge. Several issues are examined cross-nationally: equity, scope of ser vices, financing and cost controls, organizational structure, and planning. Finally, predictions of developments in the United States are made from experiences in other countries, and from the social, economic, and political style of the United States.

Emerging literature on cross-national health services systems is reviewed. Studies reveal that health services systems in many countries are converging in their egalitarian objectives, organizational forms, methods of paying providers, scope of services, & cost controls. Cross-nationally, facilities & personnel are quite similar, indicating the importance of medical technology as a shaping force. Organizational forms, payment methods, & funding sources differ widely because these are mainly social & political expressions, but these too, are converging. Countries will continue to exhibit differences in structuring inherent in their economic & political styles, from the US to the USSR. The range of difference will narrow, but not converge. Several issues are examined cross-nationally: equity, scope of services, financing & cost controls, organizational structure, & planning. Predictions of developments in the US are made from experiences in other countries & from the social, economic, & political style of the US. Modified HA.