Nearly $16 million has been shaved off this year's health budget, as the Hawke's Bay District Health Board looks forward to a "tough year".
It is getting its lowest funding increase from the Ministry of Health for "many years".
Savings must be made without harming service effectiveness the board's annual plan said.
But the plan also said it was likely services in some areas and the standard of some services "would be adjusted, and that access to some services may have to be modified".
Board chief executive Kevin Snee said the year would be tough and management had been charged with finding savings across services and support programmes.
Three things were putting the most pressure on budgets: The ageing population; growth in what could be done and people's expectations of what they could have done; and the amount of cash available, he said.
He insisted services would stay accessible and savings could be made by better productivity.
A lot of work had gone into keeping people well, particularly things like limiting hospital-caught infections and falls, he said.
The plan and budget were signed off by Minister of Health Tony Ryall this month.
Its 2013-14 budget had been set at $485m, which equates to nearly $3100 for each of the estimated 156,500 people in the region.
Just over $460m of that came from the Ministry of Health, a 1.9 per cent increase on the previous year, and was allocated by the board across its services.
The balance had to be used for particular services, including government-mandated programmes. The catchphrase "transform and sustain" had been coined to describe the cost-cutting programme.
Much of it was juggling, with all departments initially asked to try and trim 3 per cent off their budgets, board financial manager Peter Kennedy said.
In some cases that was not possible, he said, so bigger cuts had to be made elsewhere.
Of health board-provided services, the biggest cut was just over $1m from last year's $3.5m mental health spend, used to pay for treatment out of the region and a $405,000 cut paid to other mental health service providers.
But there had been an increase in the budget for board-provided mental health services of nearly $900,000.
Taking the biggest cut were disability support budgets. While there had been a $226,000 increase in that sector's board-provided services budget, the cash paid to other organisations for services had been cut by $795,000.
Funds for Maori health covering all budgets had been cut by nearly $700,000.
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