Health Spending and NCD Mortality in the Western Balkans: Trends, Outcomes, and Policy Lessons

Abstract Background Non-communicable diseases (NCDs) remain the primary causes of mortality worldwide. In the Western Balkans, cardiovascular diseases, cancers, and chronic respiratory diseases account for a substantial proportion of deaths, placing considerable strain on health systems and economies. While health expenditures increased between 2013 and 2021, the extent to which this translated into improved NCD outcomes remains uncertain. Objectives This study analyzed trends in health expenditure and NCD mortality across five Western Balkan countries-Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, and Serbia-applying the Economy of Well-being framework to evaluate whether increased health spending correlated with reduced mortality. Methods A retrospective, descriptive, and correlational design was used. Health expenditure data (% of gross domestic product) were sourced from the WHO Global Health Expenditure Database and World Bank. Age-standardized mortality rates for cardiovascular diseases, cancers, and chronic respiratory diseases were extracted from the Global Burden of Disease Study 2021. Descriptive statistics and Pearson correlation analyses were performed for 2013-2021. Results All countries reported moderate increases in health expenditure (e.g., Montenegro from 8.5% to 10.6% of GDP; North Macedonia from 6.7% to 8.5%). Despite this, cardiovascular mortality rose significantly in Albania (+120.05 per 100,000), Bosnia and Herzegovina (+70.05), and Serbia (+47.13). Cancer mortality also increased across most countries. Chronic respiratory disease mortality trends remained relatively stable. Conclusions Rising health expenditures did not consistently correspond with reductions in NCD mortality across the Western Balkans. To improve outcomes, future policies must emphasize efficient resource allocation, primary care strengthening, and preventive strategies aligned with systemic reforms. Key messages • Increased health expenditure across the Western Balkans has not consistently translated into reduced NCD mortality, highlighting the need for strategic, outcome-oriented investment. • Aligning health financing with well-being priorities requires stronger primary care systems, improved prevention strategies, and accountability mechanisms linking spending to health outcomes.