Устойчивое финансирование здравоохранения в условиях старения населения: Результаты применения различных механизмов увеличения доходов бюджета и вариантов политики

В предлагаемом кратком обзоре рассматриваются вопросы финансирования систем здравоохранения и долгосрочного ухода, а также освещаются вопросы потенциального влияния изменений в возрастной структуре населения на способность обеспечивать достаточные и стабильные бюджетные поступления из общих источников финансирования. Мы вводим новый методологический подход для моделирования воздействия старения населения на сбор доходов в бюджет от подоходного налога (включая налоги на прибыль и прирост капитала), налогов на товары и услуги, имущественных налогов и социальных отчислений. Далее рассматриваются варианты политики, направленные на устранение дефицита поступлений, который может возникнуть в результате старения населения. Подобные связанные с мерами политики выводы актуальны как для стран с большой долей стареющего населения, так и для стран, переживающих переходный период в возрастной структуре населения. Предлагаемый краткий обзор подготовлен совместно с Центром ВОЗ по развитию здравоохранения в г. Кобе, Япония.

Sustainable health financing with an ageing population: implications of different revenue raising mechanisms and policy options

This is the second brief in the Economics of Healthy and Active Ageing series. While there have been many prior analyses of how population ageing affects health and long-term care expenditure trends, very little is known about how population ageing affects a country’s ability to generate revenues to pay for health. This brief looks at how health and long-term care systems are financed and reports on the potential effects of population ageing on countries’ ability to generate sufficient and stable revenues for health from common funding sources (i.e. income taxes, consumption taxes, property taxes and social contributions) in the future. The authors simulate the effects of population ageing on countries’ ability to generate revenues, a) for countries with younger populations undergoing rapid population ageing and b) for countries that already have large populations of older adults. The analyses find that for countries where the population is comprised of a large share of relatively younger people who are likely to be active in the labour market, population ageing can have a positive impact on revenue generation from all funding sources. This leads to the challenge in many country contexts of strengthening tax collection mechanisms to take advantage of this opportunity. However, in countries with a large (and growing) older population, relying in particular on social contributions generated from the labour market to raise revenues for health is expected to result in fewer revenues per person over the coming decades. The authors consider a number of policy options to address potential revenue shortcomings as a result of population ageing.

Sustainable health financing with an ageing population: will population ageing lead to uncontrolled health expenditure growth?

The third policy brief in the Economics of Healthy and Active Ageing series looks at the long-term implications of population ageing for health spending growth. With the number and share of older people in the population increasing in nearly every country, there is much concern that this will translate into significantly higher growth in health spending in the future given that older people, on average, have higher health care costs than younger counterparts. Yet, a closer look at the evidence suggests this is unlikely to transpire, irrespective of the current and future age structure of a country. In this brief, the authors use historical data on per person health spending by age group to develop a set of projections on health care spending growth through 2060 due to population ageing for a) countries that already have a large share of the population at older ages and b) countries with relatively younger populations that are undergoing rapid population ageing. Hypothetical scenarios are also explored in recognition that health spending by age patterns might vary in the future. These scenarios are intended to approximate 1) an increase in demand and a concomitant increase in the volume of health services provided to older people; 2) an increase in the intensity of services for older people; 3) the introduction of a new high- cost medicine aimed primarily at older people; and 4) a structural change in which spending on long-term care (including health and social care) is covered by public health budgets. These analyses find that population ageing is not, and will not become, a major driver of growth in health expenditures. Moreover, they suggest that in countries where age demographics are changing but the size of the older population is not yet large, the costs of improving coverage and access to services for older people are likely to be manageable and now is a good time to begin investing in the health system while the population is relatively young. However, while population ageing will not become a main driver of health expenditure growth, policy choices related to how health services are delivered, the prices paid (or negotiated) for services, medicines and technologies, and volumes of care will ultimately determine health spending by age trends. The authors conclude by considering policy options that can be implemented to target these factors, helping to limit future growth in health expenditures within a context of population ageing.