Fresh fears are being raised in England that cuts will have to be made to the front line of the NHS if it is to cope.
The government has promised to protect the health service, but research by the King's Fund, based on interviews with 45 NHS finance chiefs, raises doubts; 19 expected care to get worse over the next few years and that 2013 could mark the turning point.
Meanwhile, a BBC survey of 1,005 people suggested 60% believed services would have to be cut.
The majority of the 45 NHS directors of finance who took part in the think tank's study said they were currently managing to make savings without harming care.
The King's Fund said these sentiments were supported by the latest performance statistics which showed the NHS was performing well.
A total of 27 of the 45 managers who took part in the online questionnaire said there was now a high or very high risk that NHS would not meet its savings targets of £20bn by 2015.
Nineteen of the panel said they expected care to worsen over the next few years, with only eight believing it would get better.
The BBC poll, carried out by ComRes, asked members of the public in England a series of questions about the NHS.
~ Some 61% agreed that they expected the NHS would have to stop providing some treatments and services in the future due to rising costs and increasing demands.
~ Nearly three-quarters also said they did not trust the government with the health service.
~ Over half of respondents said it did not matter whether private firms provided care as long as it was free of charge – the government's reforms have come under heavy criticism amid a perception they would lead to greater private sector involvement.
Prof John Appleby, chief economist at the King's Fund, said:
“There are signs that future years will be harder.
The end of the public sector pay freeze next April may add to financial pressure and increase the strain on services.
The difficulty will be finding ways to absorb these costs without compromising the quality of care for patients.”
But health minister Lord Howe maintained the NHS was “on track” to achieve its savings target:
“Waiting times have been kept low, infections have been reduced, there are more doctors, more diagnostic tests and more planned operations.”
Source: BBC News