An NHS commissioning group is considering putting a temporary ban on non-vital operations.
St Helens Clinical Commissioning Group (CCG) in Merseyside could suspend all non-essential hospital referrals for four months.
The proposal is part of a bid to help hospitals cope with increased demand during the winter despite a large funding gap.
NHS England rated the CCG "inadequate" in its 2015-16 annual assessment.
CCG lay chair Geoffrey Appleton said: "To explain it in simple terms, imagine our NHS budget is your household budget and every year the cost of living goes up but your salary doesn't increase; the result is money becomes tighter and tighter.
"Now imagine another relative comes to live with you and because of their health needs are unable to work and cannot contribute financially. How would you manage?"
He added: "Although we are trying to make as many efficiency savings as we can (buying the same or similar services for less and reducing waste), our funding gap is so large we know these measures alone will not bring a resolution and we are faced with the prospect of proposing to suspend, reduce or withdraw certain services.
"We recognise these proposals will not be popular but we will be involving those who want to have their say in the discussions and we welcome your thoughts about how we should be making cost savings."
The proposal, along with another to put a two-year suspension on IVF services for patients aged under 37, is under public consultation until October 5.
An NHS spokeswoman said: "Decisions when prioritising resources are always very difficult for commissioners but it is up to CCGs to make the best decisions for their area and work with hospitals to plan and manage demand over winter.
"St Helens CCG is actively engaging with its local population on the best way to ensure patients have their care prioritised over the busy months for the NHS.
"The 18-week target is a national objective which all CCGs and hospitals should be striving to meet."
The NHS England regional office will review the proposals before a decision is made because of the CCG's inadequate rating.