PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

7 Acting early on NCDs The Partnership for Health System Sustainability and Resilience■ Ensure NCD investments are monitored with return on investment evaluated: Require that funding decisions explicitly reference national health data, burden of disease assessments, and effectiveness evidence. Strengthen health technology assessment for NCD interventions and mandate cost-effectiveness evaluation for both existing and novel programmes, ensuring resources flow to proven interventions. ■ Implement robust monitoring with consequences for non-delivery: National strategies require not just targets but clear implementation plans with specific responsibilities, timelines, and consequences. Independent monitoring bodies should assess progress with genuine authority to recommend course corrections, with findings directly linked to budget cycles and policy decisions rather than producing reports without impact. ■ Institutionalise meaningful stakeholder engagement: Create formal mechanisms for patient and public involvement providing real influence over policy development, with adequate resources for stakeholder organisations to participate effectively. However, structure involvement to provide input and accountability without creating veto points that enable special interests to obstruct evidence-based policies. Healthcare financing CURRENT LANDSCAPE: Despite spending 9.7% of GDP on healthcare on average, all countries allocate less than 5% to prevention. Greece increased prevention spending from 1.30% to 4.50% between 2019–2022, demonstrating that reallocation is possible with political commitment. France’s ALD scheme provides comprehensive financial protection for chronic conditions, showing how layered mechanisms can address vulnerability. Yet fee-for-service remains dominant, rewarding throughput over coordination. Financial protection gaps persist even under universal coverage, with chronic disease patients facing cumulative costs over years. Regional allocation formulas rarely reflect true needs, with Italy showing two-fold per capita spending variations that reinforce geographic inequities. RECOMMENDATIONS: ■ Increase prevention investment through structural budget reforms: Move beyond marginal adjustments to meaningful reallocation of resources toward prevention, currently below 5% in all studied countries. Establish transparent tracking systems across all funding sources and protect prevention budgets through multi-year commitments reflecting the long-term nature of prevention benefits. Base investment levels on population health needs and effectiveness evidence rather than historical patterns. ■ Strengthen financial protection for chronic disease patients: minimise out-of-pocket healthcare costs and implement means-tested exemptions to provide enhanced protection for those with chronic conditions who face cumulative costs over years. Simplify administrative access to avoid excluding those most in need, and monitor financial protection by socioeconomic status to trigger policy responses when unacceptable disparities emerge. ■ Reform resource allocation to address territorial inequities: Ensure allocation formulas reflect the true costs of delivering care in different contexts, including social deprivation, infrastructure limitations, and the challenges of serving dispersed rural populations. Areas facing multiple disadvantages require additional support to achieve equitable outcomes rather than merely equal funding, with central mechanisms retaining flexibility to address persistent inequities. ■ Embed prevention value in all resource decisions: Systematically consider prevention benefits using appropriate time horizons that capture long-term value. This might involve treating prevention as investment rather than expenditure, or developing mechanisms allowing health systems to benefit from the broader economic and social savings their prevention activities generate.