PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

90 Acting early on NCDs The Partnership for Health System Sustainability and Resilienceenergy and resources. A lack of innovative financing mechanisms, such as service contracts, leasing agreements, or impact bonds for equipment and technology in Spain, has stifled diagnostic capacity in hospitals (Bernal-Delgado et al., 2024). Without sustained investment in renewal and upgrade programmes, current diagnostic advantages may disappear as equipment becomes obsolete. Precision diagnostics and molecular testing Precision diagnostics and molecular testing represent critical gaps in NCD care infrastructure, with access patterns revealing systematic inequities in who benefits from personalised medicine approaches. Japan restricts insurance coverage for cancer gene panel testing to patients with advanced solid tumours who have exhausted standard treatment options, resulting in missed therapeutic opportunities when actionable mutations are identified too late for effective intervention (HGPI, 2023). This restriction reflects both cost concerns and capacity limitations, as the country has only a limited number of centres capable of performing and interpreting comprehensive genomic profiling. The policy of restricting access until standard treatments fail means that patients who might benefit from targeted therapies as first-line treatment never receive appropriate testing. Canada has established molecular imaging Centers of Excellence, including the country’s first centre at St. Joseph’s Health Care in Ontario, featuring next-generation PET-CT scanners and integrated radiochemistry labs for personalised cancer treatment (St Joseph’s Health Care London, n.d.). Access to such advanced diagnostics remains uneven across provinces, however, with high-end technologies concentrated in major centres while other regions lack comparable molecular imaging capacity. Italy lacks systematic reimbursement for precision diagnostics in oncology despite their proven value in guiding treatment selection. Biomarker testing that could identify patients likely to respond to specific therapies remains unavailable to many in certain contexts, forcing oncologists to use trial-and-error approaches that delay effective treatment and expose patients to unnecessary toxicity. Some regions have developed local solutions, but the absence of national policy creates a postcode lottery for precision medicine access. Spain’s molecular testing capabilities are primarily located in major centres like Vall d’Hebron in Barcelona and 12 de Octubre Hospital in Madrid. As a result, patients from other regions may need to travel longer distances or wait longer for comprehensive genomic profiling compared to those in these main centres. The need for advanced equipment and specialised bioinformatics expertise means resources and services are often focused on these central locations, which can compound barriers in access for other areas. Greece’s approach to biomarker testing reveals another dimension of access inequality. Rather than systematic coverage, critical tests determining cancer treatment pathways are provided ad hoc through grants from patient associations, scientific societies, and pharmaceutical companies. This creates an inherently unstable system where access depends on charitable funding rather than clinical need, with testing availability varying unpredictably based on grant cycles and donor priorities. Access to medicines Despite evidence pointing to the crucial role that medicines have played in increasing longevity, research across countries demonstrates how access to innovative medicines reveals systemic dysfunctions in how health systems evaluate and adopt innovations, with lengthy delays between scientific advance and patient access.