2025-05-20-IMF-安道尔老龄化的财政影响_养老金和医疗保健系统改革（英）_16页_931kb

Andorra's Fiscal Challenges from Aging Population

Key Findings:

• Andorra faces a rapidly aging population due to one of the highest life expectancies (84.6 years) and lowest fertility rates (0.79 births/woman) in Europe.
• By 2050, the elderly population (65+) is projected to rise to 44% from 14% in 2020, increasing healthcare costs by €5,000 per capita for those over 80.
• Without reforms, pension spending could reach 11.3% of GDP (from 4.7% in 2022) and healthcare spending could increase to 7.8% of GDP by 2050.

System Analysis:

• Pension system has a pay-as-you-go structure (CASS & FRJ funds), contributing 44% of GDP system spending. Expected deficits emerge by 2027, with reserves exhausted by 2043.
• Healthcare system enjoys high efficiency (5.6% of GDP spend vs. EU average), but rising elderly dependency will drive costs up by 2.2 pp by 2050.
• Inward migration (net migration rate: 2.4% in 2022) has sustained the working-age population (68%), offsetting some aging pressures.

Policy Recommendations:

1. Pension Reforms:

   • Adjust contribution rates (12% → 16%).
   • Gradually increase retirement age and eliminate pension ratios (9.6 years).
   • Develop supplementary pension pillars (Pillar II/III).

2. Healthcare Reforms:

   • Promote preventive care and digitalization.
   • Value-based care and price transparency.
   • Expand elder-focused services and retain specialized medical talent.

3. Migration Strategy:

   • Proactive EU association agreements to boost labor inflow.
   • Business-friendly policies to attract skilled workers.

Conclusions:

• Inaction risks fiscal unsustainability by 2050.
• Addressing aging requires a comprehensive reform approach, combining fiscal adjustments, healthcare efficiency, and migration policies.