–Establish multisectoral coordination bodies: Create cross-ministerial mechanisms with clear mandates, adequate resources and genuine budgetary authority to align policies across health, education, finance, agriculture and urban planning sectors. These must move beyond advisory roles to have real influence over resource allocation and policy priorities. –Develop comprehensive NCD registries: Build integrated, interoperable systems tracking NCD incidence, risk factors, treatment patterns and outcomes across the entire care continuum. This requires not only technical investment but governance frameworks mandating data- sharing while protecting privacy. –Ensure investments are evidence-based: Require that funding decisions explicitly reference national health data, burden of disease assessments and effectiveness evidence, including health technology assessment (HTA) for NCD interventions. –Implement robust monitoring with accountability: National strategies require not just targets but clear implementation plans with specific responsibilities, timelines and accountability for results. Independent monitoring bodies should assess progress with genuine authority to recommend course corrections, with findings directly linked to budget cycles and policy decisions. –Institutionalize meaningful stakeholder engagement: Create formal mechanisms for patient and public involvement providing real influence over policy development, with adequate resources for stakeholder organizations to participate effectively. However, structure involvement to provide input and accountability without creating veto points enabling special interests to obstruct evidence- based policies.Policy levers Countries spend close to 10% of gross domestic product (GDP) on healthcare, yet only a small proportion of this is dedicated to preventative interventions, and payment mechanisms do not sufficiently incentivize them. Greece increased prevention allocation from 1.3% to 4.5% in 2019– 2022,55 demonstrating that reallocation is feasible with political commitment, though this increase relies heavily on temporary EU structural funds, raising questions about long-term sustainability. Fee-for-service payment remains dominant in many countries, rewarding throughput over coordination. Financial protection gaps persist even under universal coverage, with chronic disease patients facing cumulative costs over years. Furthermore, regional allocation formulas often miss the concentration of risk factors in deprived areas, the higher costs of engaging hard-to-reach populations and the infrastructure deficits that require additional investment to achieve equivalent outcomes. Out-of-pocket payments create systematic disadvantages. Greece’s poorest households spend 9% of expenses on medications alone vs. 2.7% for the wealthiest households.56 Italy recorded €40.6 billion in household out-of-pocket expenditure in 2023, showing steady annual increases outpacing income growth.57 The phenomenon of “financial toxicity” documented in Italy, where patients experiencing financial hardship face 1.2 times greater mortality risk,58 demonstrates how economic barriers translate directly into health outcomes. Payment systems reward volume over value, acute interventions over prevention and fragmented care over coordination. Germany’s fee-for-service system illustrates these perverse incentives clearly: providers receive reimbursement for each discrete service but typically receive no compensation for time spent consulting with other providers or coordinating care across settings, contributing to persistently high rates of avoidable hospitalizations for chronic conditions such as diabetes, COPD and heart failure despite the country’s substantial healthcare resources. Average primary care consultation times of only eight minutes in Germany reflect how providers respond rationally to payment incentives by maximizing volume, but such brief encounters cannot accommodate the comprehensive assessment, patient education and relationship-building that effective chronic disease management requires.3.2 Health system financing Current landscape Acting Early on Non-Communicable Diseases: A Framework for Health System Transformation 16

Acting Early on Non-Communicable Diseases 2026