'Crisis' in health care systems has become a widely discussed issue in the last 10 years. The claim for change is argued from various points of view, and according to manifold interests throughout the industrialized world. However, the present tensions of the national health service system of Hungary can be looked upon only partially in the broader terms of some 'world-phenomenon'. There are a great number of similar features, there is the great importance of temporal co-incidence, but the roots seem totally different in several respects. The paper focuses on those structural processes (historical, as well, as current), that have lead to increasing tensions and a dysfunctional working of the system, that shape the social inequalities of access to it. The main form of deeper structural tensions is the widening gap between needs and the conditions to meet them. This paper analyzes the consequences of the double pressure put on the system at its start after the war. The rapid extension of legal entitlements for free medical care was not followed by a similar extension of available resources for developing the institutions and services of the health care system. The long-term priorities given to forced industrialization and, later, to other spheres of production led to a chronic situation of 'residual' handling of various spheres of communual consumption and to the infrastructure, including programmes of health care, the pressure of rapid extension of rights and permanent scarcity of the resources has lead to a chronic shortage, overuse and 'substitutional, temporary solutions'. These constraints and tensions added further factors, producing sharp inequalities of health coming from structural social differences in life and working conditions, housing and a socially uneven distribution of burdens. The paper describes growing social inequalities both in access to relevant health care and in health status. Examples are given to show the mechanisms of how tensions within the service strengthen other types of inequalities in health.
