however the hospital result is in contrast with the results for the pharmaceutical indicators where there is no evidence of lower consumption in high expenditure cut countries this would indicate that the high expenditure cut countries have been able to protect the volumes of pharmaceutical consumed this paper has provided an overview of the recent literature that examines the links between economic downturns and health outcomes and health care use it has also summarised some of the main policy instruments that oecd countries have used to reform their health systems and reduce health expenditures