some drivers of cost increases such as productivity differentials baumol effect medical technology developments and public expectations are to some extent beyond the control of policymakers failure to contain costs would result in higher taxes or social contributions a reduction in the supply of other public services a deterioration of the quality of health services higher outofpocket payments by households or a combination of these undesirable outcomes remunerations of public health personnel are low by international standards which is related to the fact that the vast majority is public sector salaried and to the compression of remunerations in the nordic social model figure panel c and d a sharp reduction of the number of medical students in the early s as unemployment among physicians grew led to subsequent shortages which are slowly being brought down the overall shortage of doctors in municipal health centres was estimated at in down from in but up to in the worst affected region fma