Table 1.

Possible responses to fiscal stress

Responses to fiscal stress	Implementation effort	Economic pay-off	Plausible risks
Across-the-board cuts	Easy	Short-term payoff	Long-term quality reduction by penalizing well-functioning and high quality units
Operational cuts	Easy	Short-term payoff	Long-term loss of important knowledge and skills
Programme cuts	Moderate	Moderate or long-term payoff	Quality reduction and/or impaired access
Capital expenditures and investment cuts	Easy	Short-term payoff	Long-term cost increase due to cancelled maintenance
Structural reforms	Difficult	Potential long-term payoff	Effects difficult to predict. May not lead to desired outcome, or any outcome at all