Population ageing impact on health expenditure: evidence from Moldova

Abstract

Population ageing is a major demographic trend reshaping healthcare systems in Eastern Europe, including Moldova. The increasing number of older adults is likely to put more pressure on health spending, especially given limited public resources and a high proportion of out-of-pocket costs. This study aims to evaluate the potential impact of population ageing on health expenditure in Moldova up to 2040. The analysis combines National Transfer Accounts (NTA) for 2023, which provide age-specific per capita public transfers for health, with demographic projections 2023–2040. The methodology applies baseline age profiles of health spending to projected population structures and examines alternative scenarios of per capita expenditure growth. The results suggest that by 2040, the number of people aged 65 and above will grow substantially, while the proportion of those aged 80 and above will nearly double. As a result, total public health expenditures for older adults are expected to increase significantly, with their share of overall health spending rising from the current level to over one-third by 2040. The results highlight the urgent need to bolster policies on healthy ageing, long-term care, and financial protection in health to ensure sustainability and fairness in access to medical services in an ageing society.