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Mr. Masahiro Nozaki, Kenichiro Kashiwase, and Ikuo Saito
Health spending has risen rapidly in Japan. We find two-thirds of the spending increase over 1990–2011 resulted from ageing, and the rest from excess cost growth. The spending level will rise further: ageing alone will raise it by 3½ percentage points of GDP over 2010–30, and excess cost growth at the rate observed over 1990–2011 will lead to an additional increase of 2–3 percentage points of GDP. This will require a sizable increase in government transfers. Japan can introduce micro- and macro-reforms to contain health spending, and financing options should be designed to enhance equity.
Mr. Olumuyiwa S Adedeji, Huancheng Du, and Mr. Maxwell Opoku-Afari
The inclusiveness of growth depends on the extent of access to economic and social opportunities. This paper applies the concept of social opportunity function to ascertain the inclusiveness of growth episodes in selected African countries. Premised on the concept of social welfare function, inclusive growth is associated with increased average opportunities available to the population and improvement in their distribution. The paper establishes that the high growth episodes in the last decade in the selected countries came with increased average opportunities in education and health; but distribution of such opportunities varied across countries, depending on the country-specific policies underpining the growth episodes.
Mr. David Coady, Mr. Benedict J. Clements, and Mr. Sanjeev Gupta


Using cross-country analysis and case studies, this book provides new insights and potential policy responses for the key fiscal policy challenges that both advanced and emerging economies will be facing.

International Monetary Fund
The Poverty Reduction Strategy Paper discusses socioeconomic development in the Republic of Tajikistan. Although poverty reduction in rural areas is proceeding at a faster pace than in urban areas, poverty continues to be a predominantly rural phenomenon. In addition to improving the gender equality situation, there are still pressing issues related to equal access for men and women to education and land use, to the decision-making process, and to employment.
Ms. Evridiki Tsounta
Despite the increasing interest in universal health care, little is known about the optimal way to finance, design, and implement it. This paper attempts to fill this gap by providing some general policy recommendations on this important issue. While most of the paper addresses the Eastern Caribbean Currency Union (ECCU) countries, its policy implications are applicable to any country. The paper finds that the best financing option is country-specific depending on a country’s economic, cultural, institutional, demographic and epidemiological characteristics, as well as political economy considerations. However, taxation should be the primary financing source. It also concludes that an appropriate and realistic benefit package would need to be designed to ensure the system’s financial viability. Regarding the optimal way to implement universal health care, certain preconditions are needed, including sound public administration, a small informal economy, and a transparent health financing system that builds social consensus.
Mr. Peter S. Heller
Many Asian countries (such as China, Singapore, Korea, Thailand, Malaysia, Indonesia, India, and the Philippines) will experience a significant aging of their populations during the next several decades. This paper explores how these aging Asian countries are addressing and anticipating the challenges of an aging society. It suggests that Asia's preparedness for an aging population is decidedly mixed. While growth policies have been successful, much work is still needed in many countries to establish an adequate and farsighted policy framework in the areas of pensions, health insurance, and labor market policies.
International Monetary Fund
This Selected Issues paper attempts to quantify the impact of the demographic shift on growth and public finances in Switzerland. It examines the intertemporal consistency between current policy plans and unfunded liabilities, focusing primarily on social security, and explores policy options. It finds that so far, the impact of aging on the economy has been moderate. The number of pensioners has risen in recent years, but this is mainly owing to early retirees taking advantage of the generous disability and pension systems. The paper also examines the need for health care reforms in Switzerland.
International Monetary Fund
This Selected Issues paper and Statistical Appendix provides a brief assessment of Cyprus’s external position and its composition in an international perspective. It discusses estimates of Cyprus’s external position based on partial International Investment Position data as well as on cumulative flows, and compares its level and composition with advanced Organization for Economic Cooperation and Development (OECD) economies and with other accession countries. It finds that a precise assessment of Cyprus’s overall external position is hindered by the lack of data on nondebt stocks. The paper also analyzes aging and long-term fiscal sustainability in Cyprus.
International Monetary Fund
This Selected Issues paper and Statistical Appendix constructs an index of human capital for the Spanish labor force over 1977–97, and projects it over the next decade on the basis of likely demographic developments. The methodology by which the index is constructed considers both educational attainments resulting from formal schooling and improvements in workers’ productivity resulting from experience, or “learning by doing.” The results suggest that the gains from increases in formal schooling can be large, although they are translated into higher economic growth only gradually.
Mr. Peter S. Heller
The paper assesses the government expenditure effects from changing demographics in the Asian “Tiger” economies through 2050. With some exceptions, their limited social insurance commitments initially suggest that aging populations may not adversely affect fiscal balances. Yet for all the Tigers, changing illness patterns and medical modernization may combine with demographics to intensify budgetary pressures. The paper notes the implications of the Tigers’ reliance on private sector pension and medical insurance systems; the need for an active public role; and the complications for fiscal analysis when private sector instruments are used, in a mandatory way, as public policy instruments.