Do patients with haematological malignancies suffer financial burden? A cross-sectional study of patients seeking care through a publicly funded healthcare system.

BACKGROUND: It is increasingly appreciated that some patients with cancer will experience financial burden due to their disease but little is known specifically about patients with haematological malignancies. Therefore, this study aimed to measure financial toxicity experienced by patients with haematological malignancies in the context of a publicly funded health care system. METHOD: All current patients diagnosed with leukaemia, lymphoma or multiple myeloma, from two major metropolitan health services in Melbourne, Australia were invited to complete a survey capturing; patient demographics, employment status, income sources, financial coping and insurances, OOP expenses and self-reported financial toxicity using a validated measure. RESULTS: Of the 240 people approached, 113 (47 %) participated and most had leukaemia (62 %). Forty-seven (42 %) participants experienced some degree of financial toxicity using the Comprehensive Score for financial toxicity (COST) instrument. On multivariate linear regression, older age (>65 years, p = 0.007), higher monthly income (>$8000, p = 0.008), not having and being forced into unemployment or early retirement (p < 0.001) remained significantly associated with less financial toxicity. CONCLUSION: Financial toxicity is present in Australian haematology patients and those at higher risk may be patients of working age, those without private health insurance and patients that have been forced to retire early or have become unemployed due to their diagnosis.

Breast cancer costs in New Zealand's public health system.

AIM: This study aims to estimate the mean costs of breast cancer in New Zealand's public health system. METHOD: This study included women diagnosed with invasive breast cancer between 1 July 2010 and 30 June 2018 who received services in public hospitals. These patients were identified from the National Breast Cancer Register or the New Zealand Cancer Registry and linked with the Pharmaceutical Collection, National Minimum Dataset, National Non-Admitted Patient Collection and Mortality Collection. RESULTS: 22,948 breast cancer patients were included. The mean public health cost of breast cancer was NZ$44,954 per patient for the period of three months preceding and five years following cancer diagnosis, with the treatment phase accounting for 70% of the cost and the follow-up phase accounting for the remaining 30%. During the treatment phase, surgery costs accounted for the biggest proportion (35%) of the total cost, followed by immunotherapy costs (18%), radiotherapy costs (17%) and costs of diagnostic test, scan and biopsy (16%). The costs decreased substantially with age, from $69,121 for women younger than 45 years old to $23,805 for those aged 80 or over. CONCLUSIONS: The costs of breast cancer in New Zealand's public health system are substantial and have been increasing. However, outcomes of breast cancer have been improving. The results of this study can be used as a baseline of actual costs for comparing the costs of introducing new diagnosis and treatment modalities in the future.

Epidemiological Analysis of 37,424 Carotid Artery Stenosis Intervention Procedures During 11 Years in the Public Health System in Brazil: Stenting has Been More Common Than Endarterectomy.

BACKGROUND: Stroke is a leading cause of death worldwide, with carotid atherosclerosis accounting for 10-20% of cases. In Brazil, the Public Health System provides care for roughly two-thirds of the population. No studies, however, have analysed large-scale results of carotid bifurcation surgery in Brazil. METHODS: This study aimed to describe rates of carotid artery stenting (CAS) and carotid endarterectomy (CEA) performed between 2008 and 2019 in the country through web scraping of publicly available databases. RESULTS: Between 2008 and 2019, 37,424 carotid bifurcation revascularization procedures were performed, of which 22,578 were CAS (60.34%) and 14,846 (39.66%) were CEA. There were 620 in-hospital deaths (1.66%), 336 after CAS (1.48%) and 284 after CEA (1.92%) (P = 0.032). Governmental reimbursement was US$ 77,216,298.85 (79.31% of all reimbursement) for CAS procedures and US$ 20,143,009.63 (20.69%) for CEA procedures. The average cost per procedure for CAS (US$ 3,062.98) was higher than that for CEA (US$ 1,430.33) (P = 0.008). CONCLUSIONS: In Brazil, the frequency of CAS largely surpassed that of CEA. In-hospital mortality rates of CAS were significantly lower than those of CEA, although both had mortality rates within the acceptable rates as dictated by literature. The cost of CAS, however, was significantly higher. This is a pioneering analysis of carotid artery disease management in Brazil that provides, for the first time, preliminary insight into the fact that the low adoption of CEA in the country is in opposition to countries where utilization rates are higher for CEA than for CAS.

The real-world cost-effectiveness of bariatric surgery for the treatment of severe obesity: a cost-utility analysis.

BACKGROUND: Severe obesity is associated with adverse health outcomes and increased risk of death. This study evaluates the real-world cost-utility of therapy for severe obesity, from the publicly funded health care system and societal perspectives. METHODS: We conducted a cost-utility analysis using primary data from a prospective observational cohort of adults living with severe obesity (BMI ≥ 35 kg/m2 and a major medical comorbidity or BMI ≥ 40 kg/m2) who were enrolled in a regional obesity program over 2 years. We extrapolated 10-year and lifetime Markov models, validated and supplemented with literature sources, to compare medical, surgical and standard care therapies. We performed deterministic and probabilistic sensitivity analyses. RESULTS: The cohort included 500 adults living with severe obesity, 150 of whom received laparoscopic surgical therapy. From a publicly funded health system perspective, at 2 years, surgical therapy had an incremental cost-effectiveness ratio (ICER) of $54 456 per quality-adjusted life-year (QALY) compared with standard care therapy. Over a lifetime, it had an ICER of $14 056 per QALY. From the societal perspective, at 2 years, surgical therapy had an ICER of $340 per QALY; over a lifetime, it was the dominant option. The results were robust to sensitivity analysis. INTERPRETATION: From a public health care perspective, surgery for severe obesity is cost effective, and when approached from a societal perspective, it becomes cost saving. Real-world data support using surgical therapy for severe obesity, and our results contribute to the health economic and clinical literature with regard to a robust analysis from a societal perspective.

Best Buy in Public Health or Luxury Expense?: The Cost-effectiveness of a Pediatric Operating Room in Uganda From the Societal Perspective.

OBJECTIVE: To determine the cost-effectiveness of building and maintaining a dedicated pediatric operating room (OR) in Uganda from the societal perspective. BACKGROUND: Despite the heavy burden of pediatric surgical disease in low-income countries, definitive treatment is limited as surgical infrastructure is inadequate to meet the need, leading to preventable morbidity and mortality in children. METHODS: In this economic model, we used a decision tree template to compare the intervention of a dedicated pediatric OR in Uganda for a year versus the absence of a pediatric OR. Costs were included from the government, charity, and patient perspectives. OR and ward case-log informed epidemiological and patient outcomes data, and measured cost per disability adjusted life year averted and cost per life saved. The incremental cost-effectiveness ratio (ICER) was calculated between the intervention and counterfactual scenario. Costs are reported in 2015 US$ and inflated by 5.5%. FINDINGS: In Uganda, the implementation of a dedicated pediatric OR has an ICER of $37.25 per disability adjusted life year averted or $3321 per life saved, compared with no existing operating room. The ICER is well below multiple cost-effectiveness thresholds including one times the country's gross domestic product per capita ($694). The ICER remained robust under 1-way and probabilistic sensitivity analyses. CONCLUSION: Our model ICER suggests that the construction and maintenance of a dedicated pediatric operating room in sub-Saharan Africa is very-cost effective if hospital space and personnel pre-exist to staff the facility. This supports infrastructure implementation for surgery in sub-Saharan Africa as a worthwhile investment.

Potential Cost Implications of Mandatory Non-Medical Switching Policies for Biologics for Rheumatic Conditions and Inflammatory Bowel Disease in Canada.

In 2018, TNFα inhibitors were the highest cost drug class for Canadian public drug programs. In 2019, two Canadian provinces announced mandatory nonmedical switching policies in an attempt to reduce their costs by increasing biosimilar uptake. The national impact of similar policies across Canada is unknown. We conducted a cross-sectional analysis of monthly publicly funded prescription claims for infliximab, etanercept, and adalimumab between June 2015 and December 2019. We reported the market share of biosimilars for infliximab and etanercept in 2019 for each province and estimated the cost savings that public payers could have realized in 2019 if mandatory switching policies had been implemented across Canada, including a sensitivity analysis, which assumed that governments receive a 25% rebate on all biologics. Provincial drug programs spent CAD $991.84 million on infliximab, etanercept, and adalimumab in 2019, and, when biosimilars were available, they constituted only 15.5% of national utilization of these drugs. In British Columbia, the implementation of a mandatory switching policy for patients with rheumatic conditions increased the biosimilar market share of infliximab and etanercept by 299% (from 19.7% to 78.5%). If applied nationwide to all three biologics for all indications, we estimate such policies could lead to annual savings of between CAD $179.71 million and CAD $425.64 million nationally. The overall market share of biosimilars remains low in all provinces where mandatory switching policies have not been introduced. The cost implications of successfully increasing biosimilar uptake would be substantial, particularly as more biosimilars reach the Canadian market.

A global investment framework for the elimination of hepatitis B.

BACKGROUND & AIMS: More than 292 million people are living with hepatitis B worldwide and are at risk of death from cirrhosis and liver cancer. The World Health Organization (WHO) has set global targets for the elimination of viral hepatitis as a public health threat by 2030. However, current levels of global investment in viral hepatitis elimination programmes are insufficient to achieve these goals. METHODS: To catalyse political commitment and to encourage domestic and international financing, we used published modelling data and key stakeholder interviews to develop an investment framework to demonstrate the return on investment for viral hepatitis elimination. RESULTS: The framework utilises a public health approach to identify evidence-based national activities that reduce viral hepatitis-related morbidity and mortality, as well as international activities and critical enablers that allow countries to achieve maximum impact on health outcomes from their investments - in the context of the WHO's 2030 viral elimination targets. CONCLUSION: Focusing on hepatitis B, this health policy paper employs the investment framework to estimate the substantial economic benefits of investing in the elimination of hepatitis B and demonstrates how such investments could be cost saving by 2030. LAY SUMMARY: Hepatitis B infection is a major cause of death from liver disease and liver cancer globally. To reduce deaths from hepatitis B infection, we need more people to be tested and treated for hepatitis B. In this paper, we outline a framework of activities to reduce hepatitis B-related deaths and discuss ways in which governments could pay for them.

Triple-negative breast cancer incidence in the United States: ecological correlations with area-level sociodemographics, healthcare, and health behaviors.

PURPOSE: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer, more commonly diagnosed among black women than other subgroups. TNBC varies geographically, but little is known about area-level characteristics associated with elevated incidence. METHODS: We generated 2011-2013 age-adjusted TNBC incidence rates for state economic areas (SEAs) in 43 states using data from North American Association of Central Cancer Registries. For cases missing data on molecular markers, we imputed TNBC status using cross-marginal proportions. We linked these data to SEA covariates from national sources. Using linear ecological regression, we examined correlates of TNBC incidence rates for the overall population and for age (< 50 years or 50 + years)- or race (white or black)-specific subgroups. RESULTS: The mean annual incidence of TNBC across SEAs was 13.7 per 100,000 women (range = 4.5-26.3), with especially high and variable rates among African American women (mean = 20.5, range 0.0-155.1). TNBC incidence was highest in South Atlantic and East South Central Census Divisions and lowest in Mountain Division. Overall TNBC incidence was associated with SEA sociodemographics (e.g., percent of females age 45 + who are non-Hispanic black: coefficient estimate [est.] = 1.62), healthcare characteristics (e.g., percent of population without health insurance: est. = - 0.52), and health behaviors (e.g., prevalence of obesity among women: est. = 0.72) (all p < 0.05). Other variables related to TNBC incidence included density of obstetrician/gynecologists and prevalence of smoking. CONCLUSION: TNBC incidence varied across SEAs in the U.S., particularly for African American women. Identifying areas with elevated TNBC incidence can facilitate research and interventions on area- and individual-level correlates of TNBC.

Impact of COVID-19 on the cost of surgical and obstetric care: experience from a Nigerian teaching hospital and a review of the Nigerian situation.

The public health impact of the COVID-19 pandemic cannot be overstated. Its impact on the cost of surgical and obstetric care is significant. More so, in a country like Nigeria, where even before the pandemic, out-of-pocket spending (OOPS) has been the major payment method for healthcare. The increased cost of surgical and obstetric care occasioned by the pandemic has principally been due to the additional burden of ensuring the use of adequate/appropriate personal protective equipment (PPE) during patient care as a disease containment measure. These PPE are not readily available in public hospitals across Nigeria. Patients are therefore compelled to bear the financial burden of procuring scarce PPE for use by health care personnel, further increasing the already high cost of healthcare. In this study, we sought to appraise the impact of the COVID-19 pandemic on the cost of surgical and obstetric care in Nigeria, drawing from the experience from one of the major Nigerian teaching hospitals- the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State. The cost of surgical and obstetric care was reviewed and compared pre- and during the COVID-19 pandemic, deriving relevant examples from some commonly performed surgical operations in our centre (OAUTHC). We reviewed patients' hospital bills and receipts of consumables procured for surgery. Our findings revealed that the cost of surgical and obstetric care during the COVID-19 pandemic had significantly increased. We identified gaps and made relevant recommendations on measures to reduce the additional costs of surgical and obstetric care during and beyond pandemic.

The societal costs of problem gambling in Sweden.

BACKGROUND: Problem gambling is a public health issue affecting both the gamblers, their families, their employers, and society as a whole. Recent law changes in Sweden oblige local and regional health authorities to invest more in prevention and treatment of problem gambling. The economic consequences of gambling, and thereby the potential economic consequences of policy changes in the area, are unknown, as the cost of problem gambling to society has remained largely unexplored in Sweden and similar settings. METHODS: A prevalence-based cost-of-illness study for Sweden for the year 2018 was conducted. A societal approach was chosen in order to include direct costs (such as health care and legal costs), indirect costs (such as lost productivity due to unemployment), and intangible costs (such as reduced quality of life due to emotional distress). Costs were estimated by combining epidemiological and unit cost data. RESULTS: The societal costs of problem gambling amounted to 1.42 billion euros in 2018, corresponding to 0.30% of the gross domestic product. Direct costs accounted only for 13% of the total costs. Indirect costs accounted for more than half (59%) of the total costs, while intangible costs accounted for 28%. The societal costs were more than twice as high as the tax revenue from gambling in 2018. Direct and indirect costs of problem gambling combined amounted to one third of the equivalent costs of smoking and one sixth of the costs of alcohol consumption in Sweden. CONCLUSIONS: Problem gambling is increasingly recognized as a public health issue. The societal costs of it are not negligible, also in relation to major public health issues of an addictive nature such as smoking and alcohol consumption. Direct costs for prevention and treatment are very low. A stronger focus on prevention and treatment might help to reduce many of the very high indirect and intangible costs in the future.

Cost Analysis of Cancer in Brazil: A Population-Based Study of Patients Treated by Public Health System From 2001-2015.

OBJECTIVES: The aim of this study was to evaluate the federal government expenditures with oncological care, for the most incident cancer types among the Brazilian population, using registries of all patients treated by the Brazilian National Health Service (SUS) between 2001 and 2015. We adopted the formal healthcare sector perspective in this study, with the costs per patient estimated by the reimbursement price paid by the Ministry of Health to service providers. METHODS: The costs were adjusted by the follow-up time for each patient. We performed multivariate regression analysis using ordinary least squares. We analyzed 952 960 patients aged ≥19 years who underwent cancer treatment, between 2001 and 2015, for breast, prostate, colorectal, cervix, lung, and stomach cancers. RESULTS: The annual mean costs per patient (in USD purchasing power parity) was $9572.30, varying from $5782.10 for breast cancer to $16 656 for cervical cancer. Several variables predicted higher costs of cancer treatment, namely: to be male (+14%), with younger age ranges at treatment initiation, resident in the Northeast region (+26%), treated for colorectal cancer (+482%), with treatment initiation from 2010 to 2014, tumor stages III and IV (III: +182%; IV: +165%), hospitalization for other reasons besides the cancer treatment, and suffering from some a comorbidity. CONCLUSIONS: Given the forthcoming Brazilian demographic changes, which strongly suggest that the economic burden of cancer is about to increase in the near future, our estimates provide relevant information to produce useful projections about future cancer-related costs.

[COVID-19, neoliberalism and health systems in 30 european countries: relationship to deceases.] / COVID-19, neoliberalismo y sistemas sanitarios en 30 países de Europa: repercusiones en el número de fallecidos.

OBJECTIVE: The study was motivated by the need to understand the high number of deaths caused by COVID-19 in the global pandemic declared since December 2019, and how it impacted differently in European countries. The hypothesis was that less investment in the public health system, the number of doctors per inhabitant and the number of hospital beds available to the population led to a higher number of deaths after the arrival of COVID-19 in each country studied. The objective was to analyze the relationship between the number of deaths from COVID-19 in the global pandemic declared since December 2019 and health policies and investment in European countries. METHODS: A research study was conducted in which a total of six variables were analyzed with official and contrasted data: public health expenditure per capita; doctors per 1,000 inhabitants; number of beds per 1,000 people; deaths from COVID-19 per million inhabitants; number of tests to detect COVID-19 per 1,000 inhabitants; and GINI Coefficient to measure the degree of social inequality in each country. It was carried out in 30 European countries. Frequency and correlation analyses were carried out (Pearson). RESULTS: Five countries were found, which gave values above 300 deaths per million (data from April 27, 2020): United Kingdom; (305.39), France (350.16), Italy (440.67), Spain (495.99) and Belgium (612.1). Precisely, in the countries that recorded the most deaths (United Kingdom, France, Italy, Spain and Belgium) on April 27, we did not find high values of TEST performance. In our analysis, we found that the lower the investment of public spending in health (per capita), the higher the number of deaths per COVID-19 per million inhabitants, the lower the coverage of hospital beds, and the lower the number of doctors. Finally, we found that the lower the expenditure on public health, the higher the GINI coefficient (thus greater social inequality). CONCLUSIONS: A negative effect in terms of deaths was detected when investment in public health was lower; the higher number of deaths from COVID-19 was correlated (p<0.005) with greater social inequality (GINI coefficient) and with lower investment in public health (p<0.001); this had an impact on the lower number of available beds and low physician coverage per 1,000 inhabitants.

OBJETIVO: El estudio se fundamentó en la necesidad de entender el elevado número de fallecimientos por COVID-19 en la pandemia mundial declarada desde Diciembre de 2019, y cómo golpeó de forma distinta en los países de Europa. La hipótesis planteada fue que una menor inversión en el sistema de sanidad pública, el número de médicos por habitante y el número de camas hospitalarias disponibles para la población provocaron un mayor número de fallecidos tras la llegada de la COVID-19 a cada país estudiado. El objetivo fue analizar la relación entre el número de fallecimientos por COVID-19 en la pandemia mundial declarada desde diciembre de 2019 y las políticas e inversión sanitarias en los países de Europa. METODOS: Se realizó un estudio de investigación en el que se analizaron un total de seis variables con datos oficiales y contrastados: gasto público en salud per cápita; médicos por cada 1.000 habitantes; número de camas por cada 1.000 personas; muertes por COVID-19 por cada millón de habitantes; número de test para detectar COVID-19 por cada 1.000 habitantes; y Coeficiente GINI para medir el grado de desigualdad social en cada país. Se llevó a cabo en 30 países europeos. Se realizaron análisis de frecuencias y correlaciones (Pearson). RESULTADOS: Se encontraron 5 países, que fueron los que dieron valores por encima de 300 fallecidos por millón (datos de 27 de abril de 2020): Reino Unido; (305,39), Francia (350,16), Italia (440,67), España (495,99) y Bélgica (612,1). Precisamente, en los países que más muertes registraron (Reino Unido, Francia, Italia, España y Bélgica) a fecha de 27 de abril, no encontramos valores elevados de realización de TEST. En nuestros análisis, obtuvimos que a menos inversión de gasto público en salud (per cápita), se daba un mayor número de muertes por COVID-19 por cada millón de habitantes, una menor cobertura en camas hospitalarias, y un menor número de doctores. Finalmente, comprobamos que a menor fue el gasto en salud pública, más alto era el coeficiente GINI (por tanto mayor desigualdad social). CONCLUSIONES: Se detecta un efecto negativo en término de muertes cuando la inversión en salud pública es menor. El mayor número de muertes por COVID-19 está correlacionado (p<0,005) con una mayor desigualdad social (coeficiente GINI) y con una menor inversión en salud pública (p<0,001). Esto ha incidido en el menor número de camas disponibles y una baja cobertura de médicos por cada 1.000 habitantes.

Mycotoxins in Ethiopia: A Review on Prevalence, Economic and Health Impacts.

Mycotoxigenic fungi and their toxins are a global concern, causing huge economic and health impacts in developing countries such as Ethiopia, where the mycotoxin control system is inadequate. This work aimed to review the occurrences of agriculturally essential fungi such as Aspergillus, Fusarium, and Penicillium and their major mycotoxins in Ethiopian food/feedstuffs. The incidents of crucial toxins, including aflatoxins (B1, B2, G1, G2, M1), fumonisins (B1, B2), zearalenone, deoxynivalenol, and ochratoxin A, were studied. The impacts of chronic aflatoxin exposure on liver cancer risks, synergy with chronic hepatitis B infection, and possible links with Ethiopian childhood malnutrition were thoroughly examined. In addition, health risks of other potential mycotoxin exposure are also discussed, and the impacts of unsafe level of mycotoxin contaminations on economically essential export products and livestock productions were assessed. Feasible mycotoxin mitigation strategies such as biocontrol methods and binding agents (bentonite) were recommended because they are relatively cheap for low-income farmers and widely available in Ethiopia, respectively. Moreover, Ethiopian mycotoxin regulations, storage practice, adulteration practice, mycotoxin tests, and knowledge gaps among value chain actors were highlighted. Finally, sustained public awareness was suggested, along with technical and human capacity developments in the food control sector.

Smoke-free cars legislation: it works but New Zealand should still rigorously evaluate its upcoming law.

In this viewpoint we briefly review the evidence for smoke-free car legislation. We find that this legislation has been consistently associated with reduced secondhand exposure in cars with children/youth in all nine jurisdictions studied. Despite this, there are various aspects of this intervention that warrant further study-especially determining its impact on reducing tobacco-related ethnic inequalities. So we argue that the New Zealand Ministry of Health should invest in a thorough evaluation of this important upcoming public health intervention. This could both help the country in further refining the design of the law (if necessary) and would also be a valuable contribution to advancing the knowledge base for international tobacco control.

A cost-analysis of conducting population-based prevalence surveys for the validation of the elimination of trachoma as a public health problem in Amhara, Ethiopia.

BACKGROUND: Trachoma prevalence surveys, including impact surveys (TIS) and surveillance surveys (TSS), provide information to program managers on the impact of the SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) strategy and current burden of disease, and they provide a crucial component of the evidence base necessary for the validation of the elimination of trachoma as a public health problem. The prevalence surveys included in this analysis are multi-level cluster random surveys that provide population-based estimates for program planning. This study conducted an analysis of the cost of 8 rounds of TIS/TSS executed in Amhara, Ethiopia, 2012-2016, comprising 232,357 people examined over 1,828 clusters in 187 districts. METHODOLOGY AND FINDINGS: Cost data were collected retrospectively from accounting and procurement records from the implementing partner, The Carter Center, and coded by survey activity (i.e. training and field work) and input category (i.e. personnel, transportation, supplies, venue rental, and other). Estimates of staff time were obtained from The Carter Center Ethiopia. Data were analyzed by activity and input category. The mean total cost per cluster surveyed was $752 (standard deviation $101). Primary cost drivers were personnel (39.6%) and transportation (49.2%), with costs increasing in the last 3 rounds of TIS/TSS. CONCLUSION: Despite the considerable cost of conducting TIS and TSS, these surveys provide necessary information for program managers. Limited options are available to reduce the costs of TIS/TSS and gain economies of scale, as the surveys must be designed to achieve their designated sample size. However, surveys must also be designed in a way that is possible to be executed given the financial resources, personnel, and time required. Program managers can use these findings to improve estimates of the total cost of a survey and its components to ensure that sufficient resources are budgeted accordingly.

The role of local and regional authorities in prevention and control of NCDs: the case of Poland.

BACKGROUND: Freedom from noncommunicable diseases is a component of the human right to health. The obligation to reduce the pandemic of civilisation diseases should result from the provisions of the constitution, national law and local regulations. This means that representatives of local and regional communities also take responsibility for limiting the pandemic of civilisation diseases. MAIN BODY: The goal of this debate is to examine the effectiveness of the decentralised polish model for dividing the competences of preventing and combating non-communicable diseases into three levels: local, regional and central. The representatives of regional and local communities are responsible for encouraging the inhabitants of their communities to change their lifestyle: eating habits, increase physical activity, remain outdoors more frequently, reduce stimulants, and apply prevention, namely undergo regular medical check-ups and provide the body with all the necessary nutrients. Limiting the proliferation of noncommunicable diseases also requires, in vertical terms, sound financial efforts on the part of local authorities. In the example of Poland, the claim about the effectiveness of the multi-level governance model which is presented in the literature will be verified. CONCLUSION: The excessive division of competences and the dispersion of resources between regional and local authorities may hamper the effective treatment and prevention of NCDs. A lack of cooperation between the central government, which carries out an independent policy on public health, and local authorities, which use only a portion of the public funds allocated to health, obstructs the debate on priorities at the societal level and does not encourage residents to take a stand on how to allocate extra funds.