Table 2.

Analytical framework

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.