The International Monetary Fund has warned that Macau’s rapidly ageing population could push welfare spending up by 70 per cent through 2031, as authorities grapple with demographic pressure and gaps in pension adequacy. They highlight that spending on social benefits and healthcare may rise to approximately 14 per cent of gross domestic product by 2031 if the government strengthens pension provisions and healthcare services, according to the IMF’s latest assessment of the territory.
Demographic Shift Driving Fiscal Pressure
The IMF warned that the ageing of Macau’s population will bring major fiscal pressure, as spending on pensions, health care and programmes for seniors rises to match demographic shifts. It points out that Macau already satisfies the United Nations’ criterion for an ageing society, with people aged 65 and older representing 15 % of residents in 2024, compared with 7 % two decades ago.
UN forecasts cited by the IMF indicate that Macau’s senior cohort will grow by roughly 30 % by 2030 and will double by 2050, while the share of working-age people falls. Consequently, the old-age dependency ratio could climb to about 58 % in 2050, placing the territory among the world’s highest. Welfare outlays have already reached close to 9 % of GDP in 2025, up from 2 % in 2008, due to a sharp increase in senior beneficiaries, higher health-care expenses and expanded social-support programmes.
Pension Adequacy and Healthcare Strain
The IMF highlighted concerns about pension adequacy, noting that the statutory monthly old-age pension stood at MOP3,900 (US$485) in 2025, falling below both the minimum subsistence index and the statutory minimum wage. They further warned that the absence of automatic inflation adjustments has weakened retirees’ purchasing power, with SSF old-age statutory monthly pensions remaining constant at MOP3,740 during 2020–24, leading to a gradual erosion of real purchasing power over the period.
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The health-care system is feeling increasing pressure as well. In 2024, seniors accounted for 58 % of all hospital admissions and 47 % of outpatient visits, according to the data. To meet demand, the territory will need to enlarge facilities, train more staff, and add specialist services, while also expanding community-based care and supporting cross-border health cooperation within the Greater Bay Area to reduce the disparity with nearby Hong Kong.
While Macau’s healthcare outcomes remain strong, with life expectancy reaching 83.2 years, the IMF emphasized that expanding spending on healthcare services, especially for the elderly, should be a priority. They also noted that pension benefit levels remain modest, with the 2025 pension falling below key benchmarks, and the lack of automatic cost-of-living adjustments undermining retirees’ financial security over time.
Policy Scenarios and Long-Term Sustainability
The IMF’s policy scenario assumes a one-off increase in the monthly pension to the level of the minimum wage from 2026, followed by annual inflation indexation, alongside higher healthcare spending. Under these assumptions, spending could rise to around 14 per cent by 2031. Despite strong government revenues, including gaming-related income, they concluded that further reforms would be needed to ensure long-term sustainability as the population continues to age.
