Global Healthcare Strains: Challenges and Opportunities to Improve Healthcare Policies from Puerto Rico and International Case Studies

This study examines healthcare system strains in rapidly aging societies through a comparative analysis of Puerto Rico, Cuba, Japan, the Philippines, and South Korea. While existing research documents global aging and physician migration trends, few studies explore how these challenges manifest in conjunction with each other. Puerto Rico presents a critical case, with 24% of its population aged 65+, severe physician migration, and systemic underfunding under U.S. Medicaid structures. Using a structured comparative case methodology, we analyze policy responses across four nations with divergent approaches: Cuba, Japan, the Philippines, and South Korea. Data from government reports, academic literature, and World Health Organization (WHO) datasets show that (1) proactive medical education investments outperform reactive measures, (2) dedicated long-term care financing is essential but structurally unavailable in Puerto Rico, and (3) territorial status in the case of Puerto Rico, constrains policy innovation. Conventional aging frameworks are challenged by revealing how high-income territories can exhibit low systemic adaptability. Proposed are targeted reforms for Puerto Rico, including Medicaid restructuring and workforce incentives, with broader implications for aging societies under constrained sovereignty. This study fills a critical space in understanding how geopolitical contexts shape healthcare system vulnerabilities.