This publication studies the opportunities and challenges that the demographic transition poses for the Argentine economy, its most important social sectors like the healthcare, education, and social protection systems, and the potential fiscal trade-offs that must be dealt with. The study shows that even though Argentina is moving through its demographic transition, it just recently began to enjoy the window of opportunity and this constitutes a great opportunity to achieve an accumulation of capital and future economic growth. Once the window of opportunity has passed, population ageing will have a significant impact on the level of expenditure, especially spending in the social protection system. This signifies a challenge from a fiscal policy point of view, because if long-term reforms are not undertaken to mediate these effects, the demographic transition will put pressure on the reallocation of fiscal resources among social sectors. Finally, population ageing poses concerns related to sustaining the rate of economic growth with a smaller working-age population. Taking advantage of the current window of opportunities, increasing savings that will finance the accumulation of capital, and increasing future labor force productivity in this way is a challenge for the Argentine economy.

It has been over twenty years since the Brazilian Sistema Unico de Saude (Unified Health System or SUS) was formally established by the 1988 Constitution. The impetus for the SUS came in part from rising costs and a crisis in the social security system that preceded the reforms, but also from a broad-based political movement calling for democratisation and improved social rights. Building on reforms that started in the 1980s, the SUS was based on three overarching principles: (i) universal access to health services, with health defined as a citizen's right and an obligation of the state; (ii) equality of access to health care; and (iii) integrality (comprehensiveness) and continuity of care; along with several other guiding ideas, including decentralisation, increased participation, and evidence-based prioritisation. The SUS reform established health a fundamental right and duty of the state, and started a process of fundamentally transforming Brazil's health system to achieve this goal. So, what has been achieved since the SUS was established? And what challenges remain in achieving the goals that were established in 1988? These questions are the focus of this report. Specifically, it seeks to assess whether the SUS reforms have managed to transform the health system as envisaged more than 20 years ago, and whether the reforms have led to improved outcomes in terms of access to services, financial protection, and health status. Any effort to assess the performance of a health system runs into a host of challenges concerning the definition of boundaries of the 'health system', the outcomes that the assessment should focus on, data sources and quality, and the role of policies and reforms in understanding how the performance of the health system has changed over time. Building on an extensive literature on health system assessment, this report is based on a simple framework that specifies a set of health system 'building blocks', which affect a number of intermediate outcomes such as access, quality and efficiency, which, in turn, contribute to final outcomes, including health status, financial protection, and satisfaction. Based on this framework, the report starts by looking at how key building blocks of Brazil's health system have changed over time and then moves on to review performance in terms of intermediate and final outcomes.

Brazil is in the middle of a profound socioeconomic transformation driven by demographic change. Because of profound changes in mortality and, especially, fertility over the past four decades the population at older ages then begun to increase, a trend that will become more and more rapid as time progresses. While it took more than a century for France s population, aged 65 and above, to increase from 7 to 14 percent of the total population, the same demographic change will occur in the next two decades in Brazil (between 2011 and 2031). The elderly population will more than triple within the next four decades, from less than 20 million in 2010 to approximately 65 million in 2050. On the one side, these shifts in population age structure will lead to substantial additional fiscal pressures on publicly financed health care and pensions, along with substantial reductions in fiscal pressures for publicly financed education. Public transfers in Brazil have been very effective in reducing poverty among the elderly in both urban and rural areas. However, without substantial changes, the aging of the population will put a strain on the current system that will result in some critical trade-offs with consequence for poverty among other vulnerable groups and for the growth prospects of the country. One the other side, given the strong association between people s economic behavior and the life cycle, changes in the population age structure have a major impact on economic development. This book investigates the impact of demographic changes on several dimensions of the Brazilian economy and society. It does so in a comprehensive and systematic way that captures the broad complexity of issues, from economic growth to poverty, from public financing of social services and transfers to savings, from employment to health and long-term care, and their interrelations."