It should also be recognised that not all reforms have gone to plan. As outlined in the regular reviews conducted by the European Commission and European Central Bank, there have been delays in implementing some reforms and in some instances have led to unintended consequences including, for example, shortages in medical supplies and continuing arrears in paying providers of health care. The following discussion provides examples of some of the main instruments used by countries in their efforts to reduce health care expenditure and restructure national health care systems. While a substantial number of papers have been written on crisis-related reforms, the literature does not provide complete coverage. The summary reported here does not attempt to list all reforms.