Administration of medical care programs has been of concern to American public health leaders since 1916. On a world scale, there are discernible 4 principal patterns of health service organization, epitomized: (a) free enterprise, (b) social insurance, (c) public assistance, and (d) universal service. Health departments, focused traditionally or preventive service, have responsibilities also for medical care administration in rough relationship to their place in this theoretical range of country-patterns; they have least involvement in the 1st country-pattern and most in the last one. In all countries, one sees a current trend along this continuum toward the "universal service" system of health care; with this, one may expect increasingly unified health administration under health departments of the future.