This integrated review of national trends affecting the health care system is primarily intended to facilitate the planning efforts of health care providers and consumers, Government agencies, medical school administrators, health insurers, and companies in the medical market. It may also be useful to educators as a textbook to give their students some understanding of the complex interaction of various forces inside and outside the U.S. health care system. The document contains four chapters: (1) Changes in the Environment Affecting the Health Care System (Population Characteristics and Trends, Technology, and Disease Trends), (2) Government Programs and Regulation (The Government's Role in Disease Prevention and Health Research, The Government's Role in Determining the Supply of Health Manpower, Government Financing and Regulation of Health Facility Construction and Operation, The Government's Role in the Provision and Organization of Health Services, Government Financing of Health Care, Regulation of Health Service Costs and Utilization, and Implications for Health Care Providers), (3) Trends in Health Care Costs and Methods of Payments (Overall Trends in Health Care Expenditures and Costs, Hospital Expenses, The Growth of Health Insurance, Use of Health Insurance to Control Costs, National Health Insurance (NHI), Health Maintenance Organizations (HMO's), Foundations, and Appendix: The Kaiser Plan), and (4) The Health Care System (Organization of the Health Care System, Hospitals, Doctors, and Nurses). A 5-page summary and a 20-page bibliography are included. (HD)