21 September 2018

The importance and neglect of sustained personal care

Michael Hobbes writes:
In 2017, the U.S. Preventive Services Task Force...found that the decisive factor in obesity care was not the diet patients went on, but how much attention and support they received while they were on it. Participants who got more than 12 sessions with a dietician saw significant reductions in their rates of prediabetes and cardiovascular risk. Those who got less personalized care showed almost no improvement at all. Everything You Know About Obesity Is Wrong, Michael Hobbes, 'Huffpost', 19 September
Markets can't readily capture things like 'personalised care', so our political system gives them little weight. Yet they prove to be crucial in determining not only meaningful outcomes like physical and mental well-being, but also more measurable quantities, such as morbidity; elements of which can be monetarily valued. Just as reducing crime doesn't - or shouldn't - mean simply giving more cash to police forces, so improving a nation's health shouldn't just mean dispensing spending more on doctors, hospitals, dietary advice or encouraging more exercise. Unfortunately, institutions have their own goals, and that includes government itself (the bodies that dole out taxpayer funds) and the public- or private-sector agencies (that allocate these funds). These bodies have little incentive to do things that fall outside their purview, however beneficial or efficient they might be. So if more 'personalised care' is found to be the best way of tackling not only obesity but also, say mild depression, or attention deficit disorder in children, then it's unlikely to be promoted over the diets or drugs that show an immediate, financial benefit to existing organisations.

Our large, complex societies need to take a broader approach; one that rewards social outcomes. Social goals should have primacy over institutional goals. We should reward approaches that solve our social problems, even if there is currently no organisation following that approach.

Enter Social Policy Bonds. Under a bond regime, it is the social goal that's targeted, and we do not asssume that existing bodies can implement the best ways of achieving it. Non-market approaches - such as personalised care - often fall through the cracks. And finding the best approach for a particular problem at a particular time in a particular place needs a suppleness that large, top-down organisations usually lack. Our social and environmental problems need diverse, adaptive approaches. Social Policy Bonds would stimulate the research, experimentation and adoption of the best of these approaches. They would reward people for solving our problems, rather than for simply turning up to work and carrying out an approved activity. They would reward innovative approaches if they are the most efficient and, if current bodies can't implement them, they will give rise to a new type of organisation: ones whose protean composition and structure would be entirely subordinate to their goals - which would be exactly those of society. It's unlikely that existing health bodies in most countries would find room for the sort of sustained, personalised diestary advice that Mr Hobbes mentions. Social Policy Bonds targeting health, on the other hand, would encourage people to investigate such an approach and, if they find it as beneficial as it appears, see that it's adopted.

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