The head of the Southern District Health Board says she can't rule out job losses in an attempt to get its financial problems under control.
In May this year, the Southern District Health Board predicted its deficit would be just over $10 million, but on Thursday reported to board members the figure is $15 million.
The DHB says it has a three-year plan to clear its deficit by streamlining services from Otago and Southland.
Carole Heatly was appointed chief executive last year after the merger of DHBs in Otago and Southland in 2010.
"My view would be it merged in name only and we need to have a look at district-wide services, not individual services on both sites that operate in completely different ways.
"I think there are huge amounts of efficiencies that can be made by doing that, and we can also streamline care and make sure care is delivered much closer to the patient."
Ms Heatly says there will be no loss to frontline services, but backroom redundancies are possible.
"We will protect frontline services at all costs. Where we will make our economies and our savings will be in our backroom functions. The quality and standard of care will not be compromised.
"It's looking at uniting IT systems, finance systems - putting them together as one unit to service one organisation. We don't know if we'll have any redundancies - it's always an option in the future."
The Southern DHB has also brought in accounting firm Pricewaterhouse Coopers to help work out why the forecasts have been so wrong.
Carloe Heatly says the increase in the deficit is due to unforeseen one-off expenditures at the end of the financial year and wrongly predicting interest rates.