This paper seeks to explain a convergence trend in the role of the state in OECD healthcare systems. By convergence we mean that healthcare systems become increasingly similar with regards to the public/private mix in financing and service provision, and with respect to their regulatory structure. In particular, we identify increasing similarities between the three system types we delineate as National Health Service, Social Health Insurance and Private Health Insurance systems. We argue that the specific healthcare system type is an essential explanatory factor. Systems tend to feature specific, type-related deficiencies, which cannot be solved by routine mechanisms. As a consequence, non system-specific elements and innovative policies are implemented which lead to the emergence of ‘hybrid’ systems indicating a trend towards convergence.