Financing pressure, demographic change, and the public-private MIX in five health systems across continents: a comparative secondary policy analysis
Abstract
Background: Health systems may expand in nominal expenditure while still remaining under structural pressure when financing arrangements, demographic change, and the balance between public and private provision do not evolve at the same pace. Objective: To compare how five health systems across five continents-Canada, Brazil, Japan, Germany, and South Africa-express financing pressure through expenditure effort, financing composition, demographic intensity, and service-capacity strain. Methods: This study used a comparative secondary policy-analysis design based on official country profiles, policy documents, and internationally harmonised datasets. The article makes the case-selection criteria explicit, states the indicator-harmonisation rules, introduces an analytical framework linking financing architecture, demographic pressure, and service capacity, and adds a descriptive cross-case coding strategy (low/moderate/high pressure) together with simple comparative statistics to move beyond purely narrative comparison. The article does not claim causal inference and does not use patient-level data.
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