PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

52 Acting early on NCDs The Partnership for Health System Sustainability and Resiliencenavigating these processes is compounded when patients and primary care providers must coordinate across fragmented systems of approval and service delivery (CIHI, 2023) (detailed analysis of treatment access and ongoing management appears in Chapter 5, whilst medicine access delays are examined in Chapter 9). Systemic barriers across the pathway Geographic inequities in specialist access Rural and remote populations face compound disadvantages throughout specialist access pathways that transcend health system models and reflect fundamental challenges of service delivery in dispersed populations. The evidence consistently demonstrates how geographic distance interacts with specialist maldistribution to create cumulative delays: patients must travel further for initial referral, wait longer for consultation, and face additional barriers for any subsequent specialist care. Greece’s island populations requiring air or sea travel to its mainland cities, Japan’s disparities in access to specialties in rural prefectures specialties, and Poland’s rural voivodeships with specialist density half that of urban centres all illustrate how geographical disparities shape. These geographic disparities in specialist access extend beyond simple distance to encompass the full burden of accessing care. Patients face financial costs for travel and accommodation, disruption to work and family responsibilities, and the psychological stress of navigating unfamiliar urban healthcare systems – costs that fall disproportionately on populations already facing socioeconomic disadvantage. The evidence from Spain showing dramatic regional variations in specialist availability, combined with Italy’s documentation of southern patients traveling north for specialist care, demonstrates how geographic inequality compounds existing health inequities (as examined in Chapter 1). Rural patients often require multiple trips for initial consultation, follow-up assessments, and coordination between specialists, with each journey representing time, cost, and potential delays that urban patients do not face. Information flow and coordination failures The interface between primary and specialist care represents a critical weakness across all studied health systems, with information flow failures creating discontinuities in care. Despite near-universal EMR adoption in some countries, the inability to share information between sectors means referrals proceed through paper documents, test results cannot be accessed across settings and are therefore duplicated, and specialists lack the primary care context essential for informed decision- making. Japan’s 42% primary care EMR adoption compounds these challenges, whilst Spain’s achievement of 99% primary care digitalisation is undermined by only 8 of 17 regions being able to share medical records (UOC, 2022). These coordination failures extend beyond technical interoperability to reflect deeper systemic challenges examined elsewhere in this report. Payment systems that do not compensate for coordination activities (Chapter 7), governance structures that create incompatible regional systems (Chapter 6), and the absence of integrated care protocols for multimorbid patients (Chapter 5) all contribute to a disjointed experience where patients must navigate between separate providers, bearing responsibility for information transfer that health systems should provide. Lost opportunities for system learning Beyond the clinical coordination failures that affect individual patient journeys, health systems also fail to collect and analyse aggregate data that would enable system-wide learning and improvement. The systematic absence of comprehensive monitoring across specialist pathways creates institutional blindness to the very delays and failures that undermine NCD outcomes. Greece exemplifies this challenge with no national system for tracking specialist referral times, whilst