A Mixed-Method Study Protocol on Financing Health in an Ageing Nation: Developing a Healthcare Sustainability Index for Pensioned and Non-Pensioned Military Veterans in Malaysia

Aims: Malaysia’s rapid ascent as an ageing nation with 7.7% of its population now over 65 which heralds unprecedented pressure on its health system. This demographic shift exposes critical vulnerabilities in healthcare financing and access, particularly for distinct subgroups like military veterans. The pension status of Malaysian Armed Forces (MAF) veterans creates a fundamental inequity in their capacity to manage health costs, a key determinant of well-being that remains systematically unexamined. Study Design: Sequential exploratory mixed-methods design. Place and Duration of Study: All states in Malaysia with department of veteran affairs between Dec 2024 to May 2025. Methodology: This study employed a sequential exploratory mixed-methods design. Qualitative themes from in-depth interviews with 10 veterans were used to develop a quantitative survey, which was then administered to a stratified random sample of 475 MAF veterans. The core output of this analysis is the development and validation of a multidimensional Healthcare Sustainability Index (HSI), a composite measure integrating critical domains of workforce capacity, infrastructure, pharmaceutical access, and most critically, fiscal resilience. Results: The study will identify disparity in healthcare financial sustainability between pensioned and non-pensioned veterans. The validated HSI will provides a precise metric to quantify this gap, revealing that non-pensioned veterans face substantially higher risks of catastrophic health expenditure and forgoing necessary care due to cost. Conclusion: This research will provide the evidence of a pension-based healthcare inequity within Malaysia's veteran community. The HSI will serve as a vital policy tool for designing targeted, evidence-based interventions. The findings will inform strategies to strengthen government financing mechanisms, safeguard veteran well-being, and enhance the overall resilience of Malaysia’s health system in the face of demographic ageing. By proposing a replicable model for assessing financial risk protection, this study will offer insights for policymakers in Malaysia.