This paper extends recent systems approaches to US health reform to the international sphere and explicitly represents the political and economic dimensions of health policy. The worldviews of health care as an industry with user as consumer, a profession with user as patient, and a societal right with user as citizen. Historical institutionalism and agency theory in health policy are represented and integrated, with focus on the extent and interaction of hierarchical, market and network control mechanisms on key system performance goals. This work can inform simulating international comparisons of health systems evolution and explicitly representing their ‘strife’ of less tangible political and vested interests, in order tounderstand, plan and test the acceptability of proposed health reforms in various countries and regions KEYWORDS: Health Policy, Health System Dynamics, Health Politics, Health Economics.