Issue nine of Health Policy Developments is not so much about big schemes, but rather pragmatic approaches to overcoming known deficits in healthcare. It takes a closer look at new strategies in mental health care, at healthcare funding striking the right balance between individual and collective responsibility, and at hospitals searching for a new role in the face of efficient outpatient care systems. A new realism is emerging in many places. Instead of debating underlying principles along the traditional lines of ideological conflict, efforts are being made to tackle achievable objectives using feasible methodsoften following other countries beacons of excellence. After all, the objectives are often the same, with the focus on more coordination, transparency, quality and costeffectiveness. So why not export (or import) good solutions with a record of success in their countries of origin, and adapt them elsewhere? The International Network Health Policy and Reform aims to narrowthe gap between health services research and health policy. Network partners are research institutions and health policy experts from 20 industrialized countries.