After briefly reviewing some of the problems of examining 'the spatial', this paper sets out to demonstrate the importance of examining spatial configurations of health care systems. It isolates major ordering principles for understanding such systems, namely the level of economic development, political structure and ideology, and allocational mechanism. It then assesses the role of 'the spatial' in terms of system differentiation (e.g. availability, accessibility, types of care) and as confounding or modifying the impact of the major ordering principles or ideal-typifications. It concludes by suggesting that while the role of the spatial may vary from high or low (or no) significance, it should not be ignored. The combination of spatial and societal configurations in specific or comparative analyses must be undertaken cautiously.