HIN Investor Panel: The Paradox of Prevention 

Exploring new approaches to funding and incentives could help embed prevention across health, investment and society. In a recent roundtable hosted at the Academy of Medical Sciences, the HIN Investor Panel explored the challenge of investing in prevention at scale. In this collaborative article, Anna King and Emma Greenwood outline the key themes from the discussion to enable further exploration.   

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The HIN Investor Panel brings together investors, innovators and health system leaders, aiming to boost investment in evidence-based health innovation to improve health and create economic growth.  

For the latest roundtable, hosted at the Academy of Medical Sciences, the panel explored the challenge of investing in prevention at scale.  

For over half a century, major health strategies in England have repeated the same ambition: shifting from treatment to prevention. Despite overwhelming evidence, policy consensus and technological advances, prevention continues to face challenges practice.  

In this collaborative article, Anna King, Commercial Director at the Health Innovation Network South London (HIN) and Emma Greenwood, Policy Director at The Academy of Medical Sciences, outline the key themes from the discussion to enable further exploration. 

1. Short-term budgets vs long-term returns 

Prevention often stalls because the incentives underpinning the NHS, HM Treasury, investors, innovators and employers are fundamentally misaligned. The system rewards activity, not avoidance; short-term delivery, not long-term value; and measurable outputs, not invisible outcomes.  

The NHS, for example, operates with annual budget cycles but immediate performance pressures.  

Prevention, by contrast, delivers benefits over prolonged periods of time, often decades. This temporal mismatch is a fundamental barrier to investment. 

“Prevention costs are immediate, whereas benefits are delayed and diffuse”  

In an environment dominated by operational urgency, prevention is inevitably crowded out. Acute care demand, waiting list targets and workforce pressures consume resources that could otherwise be directed toward future health gains. 

The result is predictable: 

• Spending prioritises treatment over prevention 

• Investment cases for prevention appear weak in-year 

• Leaders are often disincentivised from pursuing long-term outcomes 

The NHS Fit for the Future: 10 Year Health Plan’s initiatives to “shift to long-term financial planning” were welcomed, along with the potential of more autonomy of Advanced Foundation Trusts. 

Another emerging idea is for a sovereign-style health fund could invest in long-term population health, operating outside annual budget constraints and capture returns across sectors and time horizons. 

As proposed in the roundtable: “A sovereign health fund… may be one of the only ways to break this deadlock.”   

2. Prevention as investment  

Prevention is treated as a cost rather than an investment. This framing distorts decision-making, as prevented illness or disability does not produce immediate, measurable impact. Instead, it is considered an absence, which is difficult to attribute and even harder to monetise. Without robust valuation mechanisms, prevention interventions struggle to compete for funding and resources though compelling business cases, regardless of their societal benefit. 

This imbalance was highlighted in the roundtable: “If prevention was accounted for properly, investment cases would look completely different.” So, until financial systems reflect long-term value creation, prevention will remain systematically undervalued.  

The NHS 10 Year Plan suggests plans to “take a more actuarial approach” to “pinpoint where prevention efforts are best focused”. This approach could help organisations to recognise long-term returns, with multi-year budgeting for prevention and tying funding to outcomes, rather than activity. 

3. Recognising external factors  

A major distortion in prevention economics is the presence of unpriced externalities—costs generated outside the health system but borne within it. These include poor diet, sedentary lifestyles, pollution and socioeconomic determinants of health. 

These factors drive disease incidence but are not reflected in the financial structures governing health investment. 

The consequence is a skewed system in which prevention appears expensive, treatment appears inevitable and responsibility is diffused across sectors. 

As the roundtable noted: “the true costs of unhealthy lifestyles aren’t captured where they occur.”  Without mechanisms to internalise these externalities—through taxation, regulation, or cross-sector funding—prevention will remain underfunded. 

Pricing externalities could a better align public health goals with economic signals, for example taxing unhealthy products and behaviours or incentivise healthier environments. This should ensure that the cost of not focusing on prevention is better costed when choosing to invest.   

4. Shared saving mechanisms to overcome investor constraints 

Private capital faces its own structural limitations. Venture capital and private equity funds typically operate on seven to ten year cycles, requiring relatively rapid returns. 

Prevention rarely fits into this model, as one investor explained: “Returns from prevention are long-dated and uncertain… exit timelines are often beyond fund horizons”. This creates a mismatch between the high societal value and low investor attractiveness. 

As a result, pure-play prevention ventures can struggle to raise capital. Investment often flows to diagnostics, treatment or secondary prevention, which offer shorter-term return on investment opportunities. 

By allowing investors and providers to share in downstream savings, it should be possible to create clear return on investment for prevention interventions and better aligned incentives between payers and innovators. 

5. Strengthening prevention through employers 

Employers represent one of the few stakeholders with a clearer financial incentive for prevention. Healthier employees mean reduced absenteeism; higher productivity; and lower insurance costs. 

However, as highlighted in the discussion, prevention uptake can be uneven across employee income groups, with affordability, workforce mobility and trust significantly affecting engagement. As a result, many interventions that are opt-in or self-funded might not be taken up by sections of the workforce who might benefit most. This is leading some big employers to roll out more core health and prevention benefits to all staff to ensure consistent benefits across teams. 

The NHS as the largest employer in the UK, also has scope to improve health and prevention incentives for its staff, which at the moment are small scale and dependent on local piecemeal funding. Whilst some commentators were cautious that a focus on employees could increase rather than reduce inequalities, if implemented at scale there is scope to free up resources for targeted NHS interventions for the most disadvantaged.  

Tax and regulatory systems could better encourage the expansion of workplace prevention programmes and insurance incentives focused on long-term health outcomes. There is also scope in the UK to encourage employers as testbeds for scalable interventions. 

6. Blended finance models 

Even where prevention is evidence-based and cost-effective, adoption can remain slow. 

Key barriers include lack of operational funding for implementation, insufficient incentives to change clinical practice and misalignment between data insights and actionable pathways. 

As one contributor noted: “There is always a gap between evidence and scale.”  

This gap reflects a persistent oversight: investment flows into innovation, but not into implementation and delivery.   

Blended finance can align public and private incentives by sharing risk between government and investors. A clear model combining public capital and private investment with risk and return being shared could free up money for investment in prevention. 

From Evidence to Execution 

Alignment is key to increasing investment into preventative healthcare. By redesigning the financial architecture of the healthcare system, rather than relying on incremental reform, investment flows be boosted to contribute towards long-term outcomes for people’s health and investment return. 

The Academy of Medical Sciences will continue in its vision of ‘good health for all supported by the best research and evidence’. The Health Innovation Network finds, tests, implements and scales evidence-backed innovation in health and care. Together, the organisations will continue to explore innovations that improves lives through prevention as well as treatment.  

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