But since the turn of the century, pushed by economic growth and developments in medical technologies, health expenditure as a percentage of GDP has been growing again in line with the OECD average (Nguyen et al., While higher expenditure growth than in neighbouring countries might be partly justified by previous restraint and a lower initial level of spending, the trend needs to be monitored closely as the rapidly ageing population, costly medical technology and rising patients’ expectations will generate further spending pressure. Projections from the Ministry of Social Affairs and Health (MSAH) and the OECD point to substantial increases in public expenditure on health and long-term care over coming decades.