Key points

  • Major changes, and in some cases significant cuts, are being made to health care without any programme to monitor or evaluate their impact.
  • Financial crisis presents both a stimulus for and barrier to health system reform.
  • Short-term measures to control costs have been more prevalent than efforts at structural reform, yet are unlikely to be sustainable.
  • Successful reform strategies are based on strong central leadership and constructive stakeholder dialogue and engagement.
  • The case study countries provide some, limited, evidence about the impact of austerity measures on the costs and quality of care.

This evidence scan was commissioned to support the Health Foundation’s work examining the implications of the NHS’s ‘financial gap’ for quality of care. The findings from the scan are discussed in the report, More the money: closing the NHS quality gap.

The scan aimed to provide evidence on austerity and health care from a wider international perspective, focusing in particular on the following four questions:

  • What policy responses have health systems internationally taken in response to the financial crisis?
  • How effective have these measures been in achieving cost savings and efficiencies?
  • What impact have these measures had – desired or unintended – on the quality of care?
  • What can the UK NHS learn from experiences and evidence from elsewhere?

The project took a case study approach, gathering and analysing evidence for the following six countries: Canada, Denmark, Ireland, the Netherlands, Portugal and Spain.

Further reading


More than money: closing the NHS quality gap

September 2014

This policy analysis discusses the implications of this financial gap for quality of care in the...

Event report

Can the NHS maintain quality without additional resources?

September 2014
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This report summarises the discussions at an event co-hosted by The Health Foundation and the...

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