Focusing on health outcomes

 Dr Vernon Coleman compares healthcare in the UK today to how it used to be in the 1970s:

The main single advance in medicine [in the 20th century] has been the (accidental) discovery of penicillin and other antibiotics. The discoveries of insulin, steroid hormones and a few other pharmaceutical products made a difference. But most of the essential and useful discoveries were made in the first half of the twentieth century. Since then the pharmaceutical industry has produced very little of consequence. Vaccines have been incredibly profitable for drug companies and a disaster for patients. There has been no heart drug as effective as digitalis (from the foxglove) and no pain killers as useful or as safe as aspirin (from the willow tree) and morphine (from the opium poppy). 

On the other hand the practice and management of health care has become incredibly complex, bureaucratic and expensive and patients are provided with much poorer care than their parents, their grandparents and their great grandparents. In the UK, the National Health Service has far too much money but most of it is wasted on administration, meetings, paperwork and pointless regulations. Trade unions and disciplinary bodies seem to me to be little more than outposts of the drug industry and seem to serve their interests rather than the interests of patients. Why doctors now do more harm than good, Dr Vernon Coleman, 18 April 2026

Given the widespread distrust of pharmaceutical companies, it would seem that this is the time to move towards rewarding those who achieve favourable health outcomes, rather than those who merely engage in activities purporting to deliver those outcomes. Those currently employed in healthcare are reacting rationally to the incentives on offer, to the detriment of our physical and mental health. And those incentives encourage over-screening and over-treatment, and the neglect of commercially nonnviable preventive interventions. It's the same, or worse, in the US:

The system is deemed broken, consuming 17% of GDP yet ranking last among high-income nations in life expectancy, maternal mortality, and preventable deaths, with 26 million uninsured and 43 million underinsured. Employer costs rose 160% in 20 years, driving wage stagnation and ER overuse; premiums for Obamacare and employer plans are surging in 2026 amid subsidy expirations. Shortages loom for providers, especially in rural areas, amid corporatized care and underfunded public health. US healthcare system is in crisis, James K Elsey 5 February 2025

It's time for a new approach. My suggestion is that, rather than policymakers' focusing on the means by which they think good health can be achieved, they instead focus on targets for good physical and mental health, and provide incentives for people to achieve those targets. The Social Policy Bond concept, applied to health, would do this, and more: it would inject the market's incentives and efficiencies into all the processes necessary to improve a nation's health. Health Bonds would channel our scarce resources into the most efficient means of improving our health, including those currently neglected or not even considered by our current healthcare bodies, most of which have little incentive or capacity to consider broad health outcomes that fall outside their increasingly specialised remit.

Health Bonds wouldn't stipulate how our health goals shall be achieved, nor who shall achieve them. This allows a broader approach. For example: our current compartmentalised accountancy-driven policy approach would not take into consideration the adverse health impacts of subsidising advanced driving courses for young owners of motorbikes or cars. But holders of Health Bonds would look at such measures, investigate their possible health impacts, and make an informed decision as to how any improvement they might bring to the nation's health compares to other possible interventions.