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TopIt is important to distinguish between spending cuts, which are occasionally loosely termed as “reforms,” and structural reforms. On the one hand severe outright cuts in spending are being imposed in a number of European countries (notably Ireland, Portugal, Spain and Greece) as a result of external constraints on public spending in the aftermath of the 2008 banking meltdown and the instability of national economies. Similar cuts, dressed up as “efficiency savings” are being pursued in England by the right wing coalition government with the target of cutting £20-£30 billion from spending by 2014.
Although the results of such cuts can be far-reaching and serious for those dependent on the services in the firing line, the structure and operation of the system remains largely intact. These measures are not new: as “the blunt instruments of budget constraint and cost shifting” (Tuohy, 1999, p. 4), such policies have a history reaching back at least to the 1970s, when global economic factors and the rise of neo-liberal ideology began to rein in the post-war expansion of welfare provision.
Their effect on health services varies according the scale of the cutback imposed, and whether this represents a real terms reduction in spending, or simply a restriction on the rate of increase: in many cases, as in England, where a decade of rapid real-terms expansion of health care spending has come to an abrupt and traumatic halt, to be followed by at least three years of real terms cuts, both factors apply.