With potential budget claw backs of 20% to be found in UK health care in forthcoming years, the question arises as to how these might be achieved. Based on the long-standing economic principle of marginal analysis, a framework for managing such a National Health Service credit crunch is outlined. The framework incorporates not only the natural starting point for cuts through schemes aimed at achieving the same for less cost, such as lean thinking and service redesign, but also the genuine disinvestments, in the form of stopping some services for some people, that might be required.
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