New money for chronic diseases: can clinicians and entrepreneurs deliver outcomes eluding governments?

Could savings for governments from objective reductions in preventable hospitalisations create long-term incentives for evidence-based health care?

It is to our collective shame that those with chronic conditions in Australia suffer “a miserable existence in trying to organise their health care and prevent further deterioration”.1 With more than 1 million adults with cardiovascular disease and at least 800 000 with diabetes,2 we are ill equipped for the looming “tsunami of chronic disease”.1 In our patchwork health care system, consensus-based tinkering trumps the fundamental transformation necessary to deliver a 21st century system that is fit for purpose. A gear shift in health policy towards outcomes is imperative.3 In this article, I propose a radical arrangement that rewards genuine attainment of long-term results in chronic disease management by adapting a new financial instrument known as social benefit bonds (SBBs) for this purpose. In SBBs, private investors provide up-front funding to make it possible for service providers to achieve specific outcomes of social worth. Market rates of return on investment are predicated solely on the delivery of valued outcomes.