PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

93 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceFrance’s Health Data Hub controversy illustrates different governance challenges. The platform, designed as a centralised resource for health data, has faced legal, political and technical difficulties since its inception in 2019, including numerous legal challenges over data sovereignty when using non-European cloud providers and long delays in researchers being granted access to the resource. Digital therapeutics, devices and AI applications Despite implementation challenges, several countries have pioneered innovative digital health applications that demonstrate potential for transforming NCD care. Germany was the first country to introduce statutory reimbursement for digital therapeutics through its Digital Health Applications (DiGA) framework. DiGAs are class I–IIb medical products that must comply with technical and accessibility standards and demonstrate clinical benefit. By 2024, 44 DiGAs were permanently listed, 15 were in the testing phase and 10 had been removed for insufficient evidence (GKV-Spitzenverband, 2025a). Total spending reached around €110 million in 2024, covering 423,000 prescriptions, with prices of up to €2,077 for a 90-day period. DiGAs address conditions ranging from diabetes to depression, and new developments allow data transmission to the electronic patient record (ePA). Plans to link DiGAs with disease management programmes (DMPs) may further strengthen their role in structured NCD care. At the same time, concerns remain about their effectiveness and integration into the health system. Although randomised controlled trials are often used as supporting evidence, they are not mandatory, and existing evaluations reveal a risk of bias, with many studies small in scale and limited in duration (Kolominsky-Rabas et al., 2022). Their design as standalone therapeutics may reduce pressure on the workforce but leaves limited scope for integration into existing care pathways or for tailoring to individual patient needs. Physicians also report uncertainty about when and how to prescribe DiGAs and how best to monitor their use. Finally, the relatively high costs raise questions about cost-effectiveness given the current evidence base (Kolominsky-Rabas et al., 2022). Spain has developed multiple clinical AI applications including the ALMA project for haematological disease diagnosis using machine learning algorithms, DxGPT in Madrid for rare disease identification leveraging large language models trained on clinical literature, and Andalusia’s automated medical record analysis system for early detection through pattern recognition. These applications demonstrate AI’s potential to enhance diagnostic accuracy and efficiency, particularly for complex or rare conditions where expertise is limited. The digital divide The populations most affected by NCDs, namely older adults with multiple chronic conditions, face systematic barriers to digital health adoption that threaten to exclude them from potential benefits. In Japan, 50.9% of citizens over 70 do not use smartphones or tablets, effectively excluding them from mobile health applications and digital services (Cabinet Office Japan, 2023a). Similarly, the report on Spain cites a study that found that 78% of chronic patients over 70 lack autonomy with digital tools, requiring assistance for basic functions like accessing test results or booking appointments (Plataforma de Organizaciones de Pacientes, 2023). Digital exclusion is not simply about device ownership: many older adults own devices but lack confidence or skills to use health applications. Interface designs that assume digital fluency, small text requiring good vision, and complex navigation patterns create barriers that technical training alone cannot overcome. A dependence on others for digital access undermines privacy and autonomy, core principles of patient-centred care. Family members managing digital access for elderly relatives may filter information or make decisions without full patient involvement.