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Title page 1

Contents 6

Foreword 4

Acknowledgements 5

Abbreviations and acronyms 10

Executive summary 12

1. Key challenges for social protection in Paraguay 17

Paraguay's social protection system is well-designed but coverage gaps persist 18

Low levels of social assistance expenditure are associated with limited programme coverage and insufficient benefit adequacy 19

Paraguay provides nearly universal healthcare, but the population covered by health insurance is limited 22

Contributory pension schemes in Paraguay face challenges related to both coverage and financial sustainability 25

Paraguay lacks an unemployment insurance scheme 27

There is a need to mobilize general revenues and reform contributory schemes to ensure adequate and sustainable financing of social protection 27

References 29

Notes 29

2. Financing healthcare 30

Paraguay's health system is fragmented leading to spending inefficiencies 31

The IPS health fund needs reform 34

Health insurance could become compulsory for liberal professions 45

Health insurance contribution rates paid by pensioners could be raised 46

The non-contributory healthcare scheme is primarily financed through general revenue 46

References 50

3. Financing contributory pensions 51

The fragmentation of the contributory pension system creates inequities 52

The IPS pension system faces financial challenges and parametric reforms are needed 56

The Caja Fiscal needs urgent reform for fiscal consolidation 64

References 68

4. Costs and poverty impact of expanding social assistance 70

Social assistance programmes in Paraguay face coverage gaps and low benefit adequacy 71

Selected social assistance reform scenarios 79

References 88

Notes 88

Annex 4.A. Methodology for costing selected reform scenarios for Tekoporã 89

Annex 4.B. Methodology for costing reform scenarios for Adulto Mayor 92

Annex 4.C. Methodology and data for costing reform scenarios for Hambre Cero 93

5. Mobilising general tax revenues 95

Paraguay's tax revenues are low but buoyant, increasing with economic growth 96

Paraguay's tax mix relies on indirect taxes 99

Recent tax policy and administration reforms 102

The PIT base is narrow, resulting in low revenue 104

Business taxation is a key area for base broadening in Paraguay 112

The value-added tax is efficient and generates high revenue 120

Health excise tax revenue has been declining over the past decade 122

The role of environmental taxes could be strengthened 126

Property taxes could be strengthened 127

References 129

Notes 132

Annex 5.A. Additional tables and figures 133

6. Extending social insurance to all workers 137

Social insurance coverage among the employed population remains low 138

The coverage of social insurance among employees is low 141

The average tax wedge is relatively flat, but varies across low-income salaried workers 142

Expanding social insurance coverage for employees 143

A reduced contribution base for microenterprises is intended to support formalisation 148

Access to social insurance could be extended to independent workers 150

References 154

Note 155

Annex 6.A. Characteristics of social security status by employment type 156

Tables 8

Table 1.1. Unemployment protection in South America 27

Table 2.1. Revenue and expenditure of the IPS Health Fund, 2024 35

Table 2.2. Contribution rates to the IPS 38

Table 2.3. Employee contribution rates by family status in Uruguay, 2025 41

Table 2.4. Scenarios for additional health contribution rates covering family dependants 42

Table 2.5. Annual revenue gains from introducing additional contribution rates for the inclusion of family dependants 43

Table 2.6. Public expenditure on health insurance subsidies for civil servants, 2024 43

Table 2.7. MSPBS budget for 2025 by revenue categories 47

Table 3.1. Key parameters of public pension funds in Paraguay 53

Table 3.2. Pension parameters of the Caja Fiscal by professional categories 65

Table 4.1. Main characteristics of social assistance programmes 71

Table 4.2. Coverage of social assistance programmes 73

Table 4.3. Distributive impacts of selected social assistance programmes 76

Table 4.4. Additional costs of Tekoporã reform scenarios 81

Table 4.5. Distributive impacts of Hambre Cero expansion scenarios 83

Table 4.6. Distributive impacts expansion scenarios Adulto Mayor 85

Table 4.7. Cost effectiveness of expanding social assistance programmes 87

Table 5.1. Paraguay's tax revenue potential by tax, 2023 101

Table 5.2. Progressive PIT rate schedule in Paraguay 104

Table 5.3. Revenue forgone from some deductions in the labour income PIT returns considered as a tax expenditure 110

Table 5.4. Active taxpayers under the IRE 113

Table 5.5. VAT rates and exemptions in Paraguay 120

Table 6.1. Characteristics of workers by formality and social security status 140

Table 6.2. Preferential IPS regimes for specific professional groups 144

Figures 7

Figure 1.1. Coverage of social protection in Paraguay and benchmarking countries 19

Figure 1.2. Expenditure on social assistance in Paraguay and selected countries, 2025 or latest year available 20

Figure 1.3. Coverage and adequacy of benefits of selected social assistance programmes in Paraguay, 2024 21

Figure 1.4. Health insurance coverage in Paraguay, 2024 22

Figure 1.5. Infant mortality and vaccination coverage in Paraguay 23

Figure 1.6. Government health expenditure in Paraguay and selected countries 24

Figure 1.7. Share of health expenditure by source in Paraguay and selected countries, 2022 25

Figure 1.8. Coverage of contributory and non-contributory pensions in Paraguay, 2024 25

Figure 1.9. Public pension expenditure in Paraguay as a percentage of GDP, 2020-2024 26

Figure 2.1. Healthcare providers and their users in Paraguay 31

Figure 2.2. Age-spending profiles for selected OECD countries, 2018 33

Figure 2.3. Per capita public health expenditure in Paraguay 34

Figure 2.4. Health insurance coverage under the IPS in Paraguay, 2024 36

Figure 2.5. Number of contributors and dependants under the IPS, 2014-2024 37

Figure 2.6. Health services provided by the IPS 38

Figure 2.7. Health contribution rates in Paraguay and selected countries, 2025 39

Figure 2.8. Distribution of IPS health fund contributors by income bracket - Comparative analysis of administrative and survey data 40

Figure 2.9. Distribution of civil servants by monthly health contributions under the proposed reform scenario 45

Figure 2.10. Financial development of the FONARESS fund 48

Figure 3.1. Breakdown of workers by contributory status and income quintile, 2024 52

Figure 3.2. Contributors and pensioners of the public pension schemes in Paraguay 53

Figure 3.3. Contribution years and replacement rates of the public pension funds 54

Figure 3.4. Reference wage period for pension benefits in Paraguay and selected countries, 2025 or latest year available 55

Figure 3.5. Social security contribution rates in Paraguay and selected LAC countries 57

Figure 3.6. Life expectancy and dependency ratios in Paraguay, 2025-2050 60

Figure 3.7. Number of pensioners and total pension costs as a percentage of GDP under the IPS, 2014-2023 61

Figure 3.8. Evolution of the surplus/deficit of the IPS pension fund and share of the reserve fund's returns used, 2018-2024 62

Figure 3.9. Subsidy for IPS minimum pension benefit 63

Figure 3.10. Fiscal deficit of the Caja Fiscal, 2011-2025 64

Figure 3.11. Replacement rates and contribution years by sub-scheme of the Caja Fiscal 66

Figure 4.1. Coverage rates and targeting errors in Tekoporã and Adulto Mayor by income decile 74

Figure 4.2. Coverage rates of Hambre Cero programme by region and school cycle, 2025 76

Figure 4.3. Pre and post transfer average household income 78

Figure 4.4. Lorenz curve 79

Figure 4.5. Total cost and poverty gap reduction from selected Tekoporã expansion scenarios 80

Figure 4.6. Assessing the fiscal costs of scaling up Hambre Cero 82

Figure 4.7. Costing expansion scenarios for Adulto Mayor 84

Figure 4.8. Costs and poverty-reduction impact of expanding selected social assistance programmes 86

Figure 5.1. Tax-to-GDP ratio in Paraguay and selected countries 97

Figure 5.2. Long-run tax buoyancy in Paraguay 98

Figure 5.3. Tax buoyancy by tax types in Paraguay 99

Figure 5.4. Tax mix in Paraguay and selected countries 100

Figure 5.5. Tax mix in Paraguay 100

Figure 5.6. VAT, CIT and top PIT rates in Paraguay and selected countries 102

Figure 5.7. Top and bottom marginal PIT rates in Paraguay and selected countries 105

Figure 5.8. Distribution of monthly gross income of formal employees 106

Figure 5.9. Number of taxpayers that file a PIT return by tax liability status 107

Figure 5.10. Personal income tax exemption threshold in selected OECD and LAC countries 111

Figure 5.11. Standard IRE regime vs. SIMPLE and RESIMPLE regimes 113

Figure 5.12. Distribution of IRE SIMPLE and RESIMPLE taxpayers by turnover brackets 114

Figure 5.13. Turnover thresholds for presumptive tax regimes in Paraguay and selected countries 115

Figure 5.14. Gross income thresholds for firms under the IRE and Mipymes regimes 116

Figure 5.15. FDI inflow (% of GDP) in Paraguay and selected countries, 2010-2024 117

Figure 5.16. Corporate income tax expenditures in Paraguay and selected countries 118

Figure 5.17. Breakdown of revenue forgone from tax expenditures in the corporate income tax 119

Figure 5.18. Tax expenditure in the VAT (% of GDP), 2024 121

Figure 5.19. Health excise tax revenue in Paraguay and selected countries 122

Figure 5.20. Affordability of the most sold brand of cigarettes in LAC, 2024 123

Figure 5.21. Average excise tax revenue collected per pack of 20 cigarettes sold 125

Figure 5.22. Taxes on alcoholic beverages in Paraguay and selected countries 126

Figure 5.23. Net effective carbon rates in Paraguay and selected countries 127

Figure 6.1. Social insurance coverage by employment status 138

Figure 6.2. Distribution of workers by contribution status and sector 139

Figure 6.3. Distribution of net labour income from employees' primary occupation 142

Figure 6.4. Average tax wedge of a single private sector employee 143

Figure 6.5. Minimum and average annual wages in Paraguay and selected countries, 2024 or latest years available 145

Figure 6.6. Distribution of primary salary of domestic workers 146

Figure 6.7. Breakdown of workers by age group and social security coverage 147

Figure 6.8. Distribution of net income of salaried microenterprise workers 148

Figure 6.9. Distribution of labour income of owner-managers and own-account workers 151

Figure 6.10. Own-account workers and owner-managers by profession 152

Boxes 32

Box 2.1. Health expenditure by age group in OECD countries 32

Box 2.2. Health insurance contributions for dependants in Uruguay 41

Box 2.3. Policy recommendations for health financing 49

Box 3.1. Integrating contributory and non-contributory pension schemes in Chile 58

Box 3.2. Policy recommendations on contributory pensions 67

Box 4.1. Targeting framework under Tekoporã 75

Box 4.2. Policy recommendations for social assistance 87

Box 5.1. Measures introduced under Paraguay's 2019 tax reform 102

Box 5.2. Administrative process for PIT declaration in Paraguay 105

Box 5.3. PIT deductions and exemptions in Paraguay 108

Box 5.4. Tax exemptions in the IRE 119

Box 5.5. Recommendations to mobilise tax revenues 128

Box 6.1. A snapshot of Paraguay's informal labour market 139

Box 6.2. Policy recommendations to expand social insurance coverage 152

Annex Tables 9

Annex Table 4.A.1. Costing and poverty reduction impact of Tekoporã reform scenarios on coverage extension 90

Annex Table 4.A.2. Cost of expanding Tekoporã to all eligible indigenous families by region 91

Annex Table 4.C.1. Beneficiaries of Hambre Cero 93

Annex Table 4.C.2. Projected costs of Hambre Cero after expansion to public and subsidized middle schools 94

Annex Table 5.A.1. Tax expenditures identified in the PIT in Paraguay 133

Annex Table 5.A.2. Investment tax incentive regimes in Paraguay 133

Annex Table 5.A.3. Implementation of WHO tax policy best practices - Paraguay 136

Annex Table 6.A.1. Characteristics of employees by institutional sector and social security status 156

Annex Table 6.A.2. Characteristics of owner-managers and own account workers who do not contribute to social security by institutional sector 157

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