Some countries, such as Italy, have already introduced pension reforms in recent years and face much lower fiscal gaps as a result — if these pension reforms can be sustained. Healthcare reform is a more complex issue. It does not simply deal with a system of taxes and transfers but also with the structure of a very large and complex series of markets and the incentives associated with their operations. This means that even with expenditure reforms, rising expenditures as a share of GDP may be inevitable, making tax increases a necessary condition for fiscal balance. But with a longer planning horizon tax increases can take a variety of forms, including opening the possibility of more structural reforms which are more efficient than simply increasing marginal tax rates.