NHS Grampian faces difficult funding decisions over the next five years, its board has heard.
The health authority is likely to have about £100m less to spend - from £400m down to £300m - than it thought it would, due to tightened public spending.
NHS Grampian will have £72m to spend on capital projects in the current year.
Forthcoming projects include a new emergency care centre at Aberdeen Royal Infirmary.
Chief executive Richard Carey said: "We need to plan responsibly for the future and highlight that decisions will need to be made over the next five years."