Hospital services merge plans to save £337m
More patients will be treated at home and services will be merged as part of £337m cuts over five years.
Plans have been outlined for a shake-up of health services across Herefordshire and Worcestershire.
Areas like maternity, pathology and pharmacy could be merged and more money invested in GP services to keep people out of hospital.
Worcestershire Health and Care NHS Trust said it faced "significant challenges".
The funding gap for health and social care has been revealed in a draft NHS plan up to 2020-21.
The Herefordshire and Worcestershire Sustainability and Transformation Plan states that despite receiving more money for health and care services, on current projections "this won't be enough to meet the expected demands in the future".
The plan identifies £5.4m in possible savings on planned operations.
There are also suggestions to reduce spending on low priority treatments, which at this stage are not specified.
Sarah Dugan, from the trust, said: "We do face some significant local challenges now and into the future and it is important that we address these together, as a health and care system with the support of local people."
- The amount of planned treatment should fall by 20% in real terms
- The plan envisages 200 fewer community hospital beds
- Maternity should be jointly commissioned and provided
- Three emergency departments would remain at Redditch, Hereford and Worcester, but Worcester will become the emergency centre with specialist services for the whole area
Community hospitals could become local hubs providing outpatient and support services.
Dr Mike Smith, chair of the Patients Association, said the changes were positive, but the community must be consulted.
He said treating people at home was always preferable where possible and added: "A lot of people would far rather be at home providing they can get the social care that they need."
The Wye Valley NHS Trust, which runs Hereford County Hospital, needs to make a 15% saving of £18m in 2017-18 alone. For Worcestershire Acute it is £24.9m or 9.3% of its turnover over the same period.