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National health systems throughout the world face a number of pressures in common related to demography, epidemiology, developments in science and technology, medical demand, and rising public expectations. These pressures are producing convergence in the objectives and activities of these systems in several key areas, including cost-containment, health promotion, expansion of access, primary health care, patient choice, and the linkage between health and social services. At the same time, it is also necessary to recognize the role of political and governmental processes, as well as clinical and professional variables, in shaping different societal responses to health care challenges.
Mechanic et al. (1996) studied this question.