Obviously the state needs to offer the incentives as the state (or more accurately us) foots the bill. There are a lot of models around for longer-term pay-offs but one of the better ones is a drip payment to the company providing the healthcare dependent on the patient not recurring over time - much like private sector re-offender payments.
Drip payments based on a patient 'not recurring' will simply lead to patients being refused by said company the treatment as they would see it as not worth the reduced payment received. A patient that has, say Asthma and is prone to emergency admissions due to their asthma, would likely be charged much higher for their treatment - even when likely their illness might be nothing to do with their lifestyle and everything to do wit how much their parents smoked in their presence growing up as children or the smoggy air that plagues their environment. This patient being penalised for 'recurring' health issues seems totally unfair. This is also acknowledging that the company will likely have little that they can do to effect this person's risk of having their life continually blighted by their asthma (apart from advising them to not smoke etc, which they might already adhere to anyway).
Why? Why is it the state's role to get involved?
Everyone knows smoking is bad, everyone knows eating poorly and a lack of exercise is bad. People should be allowed to make their own mistakes otherwise you lose the incentive to not get things wrong.
Everyone knows this on the whole, true. But is society in general geared towards eating better food for example? Is it not cheaper to eat crap food often as well, not to mention the bombardment of advertising of said crap food when compared to food that would be better? If the landscape was much more geared to making it a much more hardened and not just passive choice to eat poorly and smoke (e.g. much more expensive crap food, much more expensive cigarettes, much less daytime advertising of crap food like McDonalds etc) then yes totally people perhaps should be allowed to make those mistakes as you say. But that is not the reality, and we don't chip and monitor everyone's individual intake of these things so we cannot charge differently for treatments related to these on a case-by-case basis.
Also how far would you go with this model? Do you refuse to treat people who develop hepatitis C in their 50s because they took what they thought were mild drugs back in their teens? Do you refuse free HIV treatment to the unlucky sod who had one moment of unprotected sex with his then girlfriend who happened to have one fling with a airline pilot two years previously? To me the "you made the mistake, now you pay extra for the treatment" only works if there are only direct single risks associated with the ailment in question. And we'd likely need everybody chipped to have details of all that they do as well!
Have hospitals publish success rates, waiting times, etc. - we're a good part of the way there already.
Hospitals already do as you say. Or rather the GOVERNMENT do. Hospitals left to their own devices would only publish what makes them look great. Again, it all comes down to a government overseer/arbiter...
The more it costs to provide, the more the state pays for the provision. The private sector, without a bottomless pit of money, will always find more efficient ways to provide these services.
The private sector can find efficient ways to provide services. That can also involve lies, deceit and outright fraud (see Enron, rigging of Libor rates and the 2007/2008 credit crunch bubble etc).
The healthcare sector is one of the few areas that should be steered clear of such rampant profiteering as it would literally become issues of life and death in many cases. You could easily see a situation like, say, over 65s not offered certain operations because they are considered 'too expensive' and 'being done on people likely not to gain a profit within 5 years' or something like that; which might go against medical evidence but keep overheads lower and profits higher.
Also bear in mind that re-investing profits into service improvement for a company based in Nevada who are providing healthcare in Egham may be much more random with remote shareholders to pay dividends to. Surpluses built up by Government-run services are much more likely to be re-invested in long-term service improvements.
The state funded/privately provided model is perfect for what you've described. What better incentive to get people in to have health checkups than the possibility of being able to provide some expensive healthcare afterwards?
The incentive is on the company; but is the incentive on the patient though to pay for these things? Are these necessities or luxuries?
Of all the people I would trust to run anything (even something far more simple than healthcare) the government (and especially their army of civil servants) are pretty close to the bottom of that list.
I don't buy the suggestion that regions would struggle - I think they'd fare even better. Think about it - if you wanted to make money out of healthcare, what better than a Methadone clinic in Liverpool or a Gastric band centre in Saudi Sportswashing Machine?
I'll leave things there...
