A new report, Sustainable Healthcare Systems: An International Study, has been published. This report reveals how well the existing healthcare systems in 11 countries are coping with the challenges of changing demographics and technological and economic change. It has been suggested that the merits of a particular healthcare system can be judged by a number of criteria, namely: quality, efficiency, acceptability, and equity. Looking at the healthcare systems reviewed there are examples of systems that might be regarded as unbalanced in relation to these criteria. For example, the US healthcare system scores very highly in relation to quality, but many commentators argue that it scores badly in relation to equity and efficiency. On the other hand, the healthcare system in a developing country such as Malawi might have limitations in relation to care quality and equity between different parts of the population, but probably does quite well on efficiency given the limited resources available. In yet other healthcare systems there seems to be a better balance between these four criteria. Given the different requirements and structures of different countries it is not surprising that a single ‘one-system-fits-all’ approach is not tenable. This research has identified that in the countries reviewed the impact of financial and economic austerity has been significant. Moreover, in spite of the variety of healthcare systems to be found in those countries, the impact of austerity over the last few years linked with an increasing demand for healthcare services, indicates that existing systems are unlikely to remain sustainable in the longer term. Possible ways of dealing with the impact of these external drivers would, by and large, have significant implications for existing healthcare systems. The problem is that in non-authoritarian democratic countries there is likely to be much resistance to any such changes. Thus perhaps the key message is for politicians and healthcare managers and professionals in those countries to devise ways of communicating the essential need for such changes and the means by which they should be implemented.