Making healthcare and pensions growth-resilient

EU Horizon Europe report by Christine Corlet Walker and Dario Leoni
September 2026

Summary

This report, as part of the MAPS project, looks at whether European healthcare and pension systems can remain sustainable if economies stop growing or begin to shrink. More broadly, it examines how these systems can be made resilient and capable of supporting wellbeing in a post-growth economy.

It examines healthcare and pension systems in the UK, Italy, Finland and the Netherlands, combining country case studies with economic modelling of the UK.

Healthcare

Healthcare systems currently rely on economic growth in several ways, including rising healthcare needs, higher staff costs, new medical technologies and profit extraction by private companies. None of the four countries examined emerges as clearly more resilient than the others. Instead, each faces different challenges shaped by its socio-demographic profile, welfare financing model, governance structures and cost-containment institutions.

A consistent finding across all four cases is that growth dependencies are already affecting healthcare systems, even in growing economies. Importantly, the costs of these pressures are being passed on to healthcare workers through understaffing and pay constraints, and to patients through unmet healthcare needs and higher out-of-pocket costs. If these underlying pressures are not meaningfully addressed, they are likely to become worse as economic growth slows.

The report highlights the potential benefits of tax-funded healthcare, stronger controls on pharmaceutical and technology costs, and better regulation of private profit-making.

Pensions

Pension systems also depend, in different ways, on a growing economy. Pay-as-you-go systems rely mainly on income from workers, while funded systems rely on investment returns. Neither is completely independent of economic growth, but their vulnerabilities differ.

Finland and the Netherlands appear best prepared for a post-growth future, while Italy faces financial and inequality challenges, and the UK has particularly high pension inequality. The report suggests reforms such as limits on very high pension payments to improve fairness while protecting the financial sustainability of pension systems.

The UK modelling

The UK modelling simulates five post-growth transition scenarios using a stock-flow consistent model, UK-PADME. The simulations emphasise that, without accompanying policies, a post-growth transition is likely to produce a sharp rise in pension and healthcare spending as a share of a shrinking GDP, with public debt climbing to unsustainable levels even if the tax take increases substantially.

However, a combination of healthcare and pension reforms could make the system more resilient, keep debt under control and still improve healthcare provision. Possible measures include reducing overmedicalisation and changing how pension benefits increase over time.

Overall message

Taken together, the report argues that growth dependencies in healthcare and pension systems are already in play, but that these pressures are often hidden by shifting costs onto workers, patients and future generations. Moving towards a functional post-growth economy will therefore require deliberate reforms to reduce these dependencies, rather than relying on continued economic expansion.

A central theme is reducing inequality. Greater inequality can make economic growth appear necessary because governments can avoid difficult questions about redistribution. Tackling inequality directly could therefore both improve fairness and make healthcare and pension systems less dependent on growth.

Ultimately, the report shows that wellbeing and environmental sustainability do not necessarily require endless economic growth. Achieving this, however, will require significant changes to how welfare systems are designed and funded, so that they can support people’s wellbeing without relying on continued economic expansion.

Further Reading