국가전략정보포털

Title page

Contents

Abstract 3

Resume 4

1. Introduction 5

2. Background 6

2.1. Population ageing and public finances 6

2.2. Asymmetric impact across levels of government 7

3. Impact of population ageing on levels of government 10

3.1. Revenues 10

3.2. Health expenditures 16

3.3. Combined impact of population ageing on government revenues and health expenditures 18

3.4. Policy implications for fiscal federalism 20

References 26

Annex A: Population ageing across OECD countries 29

Annex B: Projecting government revenues 30

Annex C: Projecting health expenditures 32

Annex D: The perspective of the funder for health care expenditures 36

Figure 1. Tax revenue composition across levels of government in OECD countries 8

Figure 2. SNGs' health expenditure as a percentage of general government (as of 2019 - pre COVID-19) 9

Figure 3. Changes in the structure of the population and buoyancy effects on government revenues (annual real growth between 2018 to 2040) 11

Figure 4. Government revenue growth in real terms from 2018 to 2040 across levels of government (annual real growth rate) 14

Figure 5. Government revenue growth as a share of GDP growth across levels of government (2018 to 2040) 15

Figure 6. Growth in health care expenditure from public sources in excess of GDP growth 16

Figure 7. Increase in the ratio of health expenditure to total from 2018 to 2040 17

Figure 8. Health expenditure in real terms growth from 2018 to 2040 and health expenditure ratio 18

Figure 9. Comparison of health expenditure and government revenues growth from 2018 to 2040 20

Figure 10. Increase in the health expenditure-to-revenue ratio from 2018 to 2040 21

Figure 11. Marginal effect of decentralisation on public spending and life expectancy 23

Boxes

Box 1. Summary of the main conclusions 6

Box 2. Fiscal policies to increase resilience of revenues to population ageing 12

Box 3. Making health systems more efficient and resilient 19

Box 4. Decentralisation of health care 23

Box 5. Australia's long-term fiscal sustainability monitoring 25

Annex Figures

Figure A1. Working-age population as a percentage of total population 29

Figure D1. SNGs' health expenditure as a percentage of general government's 36

Figure D2. Increase in the health expenditure-to-revenue ratio from 2018 to 2040 - "funded by" perspective 37