Table 2 Analytical framework

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.