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Table 2 Analytical framework

From: Decommissioning in a local healthcare system in Sweden: responses to fiscal stress

Responses to fiscal stress Examples of saving instruments Plausible effects
Across-the-board cuts All divisions are cut back in equal amounts or percentages Short-term economic payoff and easy to implement. Might create long-term quality reduction by penalizing well-functioning and high quality units.
Operational cuts Personnel costs
Reduce or control overtime
Salary cuts, e.g., wage freeze or stalled salary increases
Slowdown of promotions
Early retirement
Fill positions with less credentialed or lower-paid staff
Hiring freezes
Eliminating positions
Layoffs
Non-personnel costs
Restrict or ban spending on supplies, utilities and equipment
Restrict or ban spending on travels, conferences and complementary training
Short-term economic payoff and easy to implement. Might create long-term loss of important knowledge and skills.
Programme cuts Reduce quality requirements for healthcare provision
Reduce variety of service tasks
Standardise service forms and content
Increase wait times
Reduce service supply, e.g., by terminating programs, limiting service hours, closing service facilities or units
Reduce public entitlements levels
Limit reception time
Introduce or increase user fees such as item charges, transport costs or fees for service
Substitution of services or treatmens to reduce costs
Moderate or long-term economic payoff and moderate effort to implement. Might create quality reductions and impaired access.
Capital expenditures and investments cuts Spending freezes for new capital projects and investments
Deferral of non-essential capital projects and investments
Deferral of maintenance of facilities and equipment
Short-term economic payoff and easy to implement. Might create long-term cost increase due to cancelled maintenance.
Structural reforms Optimze old and introduce new work methods or work processes
Merge service facilities or units (without laying off staff)
Merge or centralize administrative tasks (whitout laying off staff)
Digitilize public services
New governance structures, such as outsourcing of public tasks
Potentially long-term economic payoff but difficult to implement. The effects are typically difficult to predict and the reforms may not lead to desired outcome.