Economists have warned ministers will need to find up to £16billion of annual cost savings or raise taxes due to an unhealthy and ageing population.
The Scottish Fiscal Commission said the required increase under its forecasts needed to pay for rising healthcare costs was "likely to be unsustainable".
The commission predicts a widening gap between what Scotland would have to spend on health and the funding it receives.
In its fiscal sustainability report for 2025, the SFC looked at the long-term risks of demographic trends for population and ageing.
It highlights projections showing a 26% increase in those aged between 75 and 85 over the next 25 years, while the numbers of those aged over 85 rise by 95%.
Professor Graeme Roy, the SFC chairman, said “cuts to public spending or increased taxes” would be needed to balance Scotland’s budget.
He added: “Scotland faces a real challenge in terms of its overall fiscal sustainability because of this twin challenge of an ageing population and also an unhealthy population.”
The commission has warned that annual spending per person increases significantly for those in their seventies or older, and an ageing population will lead to "upward pressure in health spending".
The SFC’s worst-case scenario sees an average budget gap of £16billion from 2029-30 through to 2074-75.
It also estimates that public spending in other areas would have to fall by 1.2% annually to balance the need to put more money into healthcare.
Read the full story in The Times.