Shrinking budgets, improving care: Trade-offs are unavoidable

BMJ 2010; 340 doi: (Published 17 March 2010) Cite this as: BMJ 2010;340:c1259
  1. Yair Zalmanovitch, head ,
  2. Dana R Vashdi, lecturer
  1. 1Division of Public Administration and Policy, University of Haifa, Haifa 31905, Israel
  1. Correspondence to: Y Zalmanovitch yairz{at}
  • Accepted 16 February 2010

All countries are facing the question of how to maintain the quality of care in the face of static or shrinking health budgets. In the NHS it’s estimated that savings of over £20bn need to be made in the next few years. Graham Rich (doi:10.1136/bmj.c1251) and Phil Leonard (doi:10.1136/bmj.c1258) argue that the NHS can save money while maintaining and improving the quality of care and set out their views on how to do this. But Yair Zalmanovitch and Dana Vashdi think that something will have to suffer

The recent financial crisis and subsequent economic recession have placed healthcare systems in most parts of the world under extreme pressure. Expensive technological developments, the substantial cost of highly trained labour; and increasing longevity make health care a highly demanding and costly industry. And even before the recession, rising healthcare expenditure was a preoccupation for many governments. Politicians, their constituents, and the entire health industry now face an enormous challenge to find new directions in policy.

Beyond the cultural, political, and ideological arguments that have been extensively discussed,1 there are three critical broad objectives with inherent policy trade-offs that must be considered in any debate on healthcare policy: high quality, disciplined funding, …

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