title: The fiscal crisis in the health sector: Patterns of cutback management across Europe.
abstract: OBJECTIVE
  The article investigates trends in health sector cutback management strategies occurred during the ongoing financial and fiscal crisis across Europe.
  
  
  METHODS
  A European-wide survey to top public healthcare managers was conducted in ten different countries to understand their perception about public sector policy reactions to the financial and economic crisis; answers from 760 respondents from the healthcare sector (30.7% response rate) were analyzed.
  
  
  METHODS
  A multinomial logistic regression was used to assess the characteristics of respondents, countries' institutional healthcare models and the trend in public health resources availability during the crisis associated to the decision to introduce unselective cuts, targeted cuts or efficiency savings measures.
  
  
  RESULTS
  Differentiated responses to the fiscal crisis that buffeted public finances were reported both across and within countries. Organizational position of respondents is significant in explaining the perceived cutback management approach introduced, where decentralized positions detect a higher use of linear cuts compared to their colleagues working in central level organizations. Compared to Bismark-like systems Beveridge-like ones favour the introduction of targeted cuts. Postponing the implementation of new programmes and containing expenses through instruments like pay freezes are some of the most popular responses adopted, while outright staff layoffs or reduction of frontline services have been more selectively employed.
  
  
  CONCLUSIONS
  To cope with the effects of the fiscal crisis healthcare systems are undergoing important changes, possibly also affecting the scope of universal coverage.
authors.affiliation: Northumbria University, Department of Social Sciences and Languages, Lipman Building, Newcastle Upon Tyne NE1 8ST, United Kingdom; Department of Policy Analysis and Public Management, Bocconi Universtiy, Via Roentgen, 1, 20136 Milan, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Ongaro
authors.affiliation: Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Via Roentgen, 1, 20136 Milan, Italy; Università degli Studi di Parma, Strada Dell'Università, 12, 43121 Parma, Italy. Electronic address: francesca.ferre@unibocconi.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ferré
authors.affiliation: Department of Policy Analysis and Public Management, Bocconi Universtiy, Via Roentgen, 1, 20136 Milan, Italy; Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Via Roentgen, 1, 20136 Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fattore
mesh_terms: D057172:Economic Recession; D005060:Europe; D000070586:Fiscal Policy; D019981:Health Care Sector / Q000191:economics*; D005102:Health Expenditures / Q000639:trends*; D006291:Health Policy / Q000191:economics; D006295:Health Resources / Q000458:organization & administration; D006801:Humans; D011640:Public Policy
keywords: Cut back management; Europe; Financial crisis; Fiscal crisis