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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
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