PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

74 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceFigure 17: Out-of-pocket spending on health as share of final household consumption, 2021 (or nearest year) Source: OECD, 2023a. France has developed one of the most comprehensive approach to financial protection among studied countries, demonstrating how layered mechanisms can address different sources of financial vulnerability. The country’s universal statutory health insurance provides base coverage for all residents. This is complemented by supplementary insurance held by 96% of the population, typically through employers or mutual societies. While the Long-Term Illness (ALD) scheme offers 100% reimbursement for thirty designated chronic conditions, patients are still required to pay deductibles and any additional charges resulting from overbilling, which is permitted in many cases. These out-of-pocket costs can accumulate for NCD patients requiring multiple medications, particularly for those without comprehensive complementary insurance. Low-income individuals receive additional protection through the Complémentaire Santé Solidaire, which provides free supplementary coverage. However, there are concerns regarding the sustainability of the ALD system, as the list of included diseases and the number of beneficiaries is growing. A recent interministerial mission has recommended that, amongst other things, improving preventive strategies will be important to secure the long-term sustainability of the scheme. The tension between comprehensive coverage and fiscal sustainability reflects broader challenges facing all health systems as NCD prevalence increases, making evidence of cost-effectiveness paramount. Indirect costs and hidden barriers Financial barriers often operate indirectly through travel costs, lost wages from time off work, and informal payments that disproportionately affect vulnerable populations. Greece reports 9.0% unmet medical care needs compared to the 2.2% EU average, but this figure masks dramatic disparities: low-income households experience three times higher rates of unmet needs than wealthy households (OECD/European Observatory on Health Systems and Policies, 2023b). These indirect costs accumulate across the multiple appointments required for chronic disease management, creating barriers that may exceed direct medical costs. Japan’s experience illustrates how indirect costs affect access even in systems with comprehensive coverage. Rural populations often face substantial barriers when seeking specialist care which can results in associated costs and disruptions in continuity of care. These costs, not covered by 2.22.32.43.23.33.64.04.6 FrancePolandJapanGermanyCanadaItalySpainGreece