PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

72 Acting early on NCDs The Partnership for Health System Sustainability and Resilience2024b). This rapid increase demonstrates that significant reallocation is technically possible when political commitment aligns with institutional capacity. However, Greece’s progress relies heavily on EU structural funds and recovery funding that may not be sustained beyond current programming periods, raising fundamental questions about the sustainability of prevention investments dependent on external support rather than domestic political consensus. Structural barriers to investment in prevention The challenge extends beyond the quantity of prevention spending to encompass how these limited funds are allocated and whether they achieve intended impacts. Prevention budgets often fragment across multiple agencies and programmes without coordination or systematic evaluation of effectiveness. Budget processes operating on annual cycles struggle to capture and value prevention benefits that accrue over decades. Professional payment systems continue to reward procedures and prescriptions rather than health maintenance activities. Political incentives favour visible, immediate interventions that voters can see and appreciate over gradual population health improvements that may only become apparent across electoral cycles. The fragmentation of prevention funding creates particular challenges. In Canada, prevention activities are financed through a mix of federal transfers, provincial and territorial budgets, and municipal public health programmes, with limited coordination across levels (Marchildon et al., 2021; PHAC, 2021; NCCHPP-CCNPPS, 2018). This fragmentation means that comprehensive prevention strategies requiring action across multiple domains, such as addressing obesity through nutrition, physical activity, and environmental interventions, struggle to secure coherent and sustained funding. Each funding stream applies its own criteria, timelines, and accountability requirements, creating administrative burden that diverts resources from actual prevention activities. Italy’s experience with EU Recovery and Resilience Fund allocations illustrates both opportunities and limitations. The country allocated €524 million to health through Mission 6 of its Recovery and Resilience Plan with a strong focus on chronic disease prevention, including €324 million targeted at high-impact conditions. One-off initiatives have also been taken to address cardiovascular health, including CV-PREVITAL (€10 million allocated in 2018) and CVRISK-IT (€20 million over four years from 2025). This use of EU funds demonstrates that NCD care is considered an important element of improving countries’ resilience across the EU. However, this injection of funding does not address structural imbalances in resource allocation within the Italian national healthcare budget or the need for a focus on reducing inequalities. Once funding ends, there is no clear mechanism for sustaining these investments through regular budget processes. Financial protection High levels of public insurance coverage, achieved through various models across the studied countries, have not eliminated financial barriers to NCD care, particularly for vulnerable populations with complex chronic conditions. Out-of-pocket payments create systematic disadvantages that disproportionately affect those with the greatest health needs and least financial capacity. Direct financial barriers Spain’s out-of-pocket payments represent 21% of total healthcare spending compared to the EU average of 15%, a gap that, despite coverage through voluntary health insurance (VHI), can present a significant financial barrier due to co-payments for medications, dental care, and other services not fully covered by the public system. These co-payments particularly affect chronic disease patients who require multiple medications and regular monitoring, with costs accumulating over time to create substantial financial burden (OECD/European Observatory on Health Systems and Policies, 2023a).