Patients don’t want to go to hospital, with Dr Angela Kwong

“Patients don’t want to go to hospital. Patients don’t want knee replacements. Patients don’t want interventions.”

That observation from Dr Angela Kwong might sound obvious, but it captures one of the biggest opportunities facing Australian healthcare.

Most people want the same outcome. They want to stay healthy, remain independent, avoid chronic disease and live well for as long as possible. Governments want healthier populations. Clinicians want healthier patients. Insurers want fewer preventable claims. Yet despite broad agreement on the destination, much of the system remains focused on what happens after health deteriorates rather than helping people avoid those outcomes in the first place.

That tension sat at the centre of my recent conversation with Angela, GP, obesity management advocate and founder of Enlighten Me. While our discussion began with obesity management, it quickly expanded into prevention, incentives, funding models and what it takes to create meaningful and lasting behaviour change.

Obesity is usually the symptom

One of the most interesting aspects of Angela’s approach is that she doesn’t start with weight. Instead, she starts with understanding why the weight exists in the first place.

For some patients, the driver may be emotional eating. For others it might be food trauma, thyroid disease, insulin resistance, medication side effects or a combination of factors that have accumulated over time. The common thread is that obesity is often the visible symptom of a much broader issue.

That perspective challenges the way many healthcare interventions are designed. The temptation is often to focus on the outcome we can see rather than the causes sitting underneath it. Weight loss becomes the goal, rather than understanding the behaviours, circumstances and conditions that created the problem.

It’s a useful reminder that sustainable health outcomes rarely come from treating symptoms alone.

Why the system struggles with prevention

Three years ago, Angela built Enlighten Me around a multidisciplinary model of care that combines medical treatment, nutrition, exercise physiology and behavioural support.

The idea itself isn’t particularly controversial. Most healthcare professionals would agree that obesity is a complex condition requiring multiple forms of support. The challenge is that our healthcare system wasn’t really designed around that model.

Medicare generally funds consultations. Private health insurance generally funds episodes of care. Prevention programs often sit somewhere between the two.

As a result, many of the services that could potentially create the greatest long-term impact can be difficult to fund through traditional mechanisms. Rather than redesigning the service to fit the funding model, Angela built the service around what she believed patients needed and then tested whether patients would see enough value to pay for it directly.

Many did.

That result is particularly interesting when viewed through the lens of private health insurance. One of the arguments I explored in How Community Rating Shapes Australia’s Health Insurance is that Australia’s system creates unusually strong incentives for insurers to improve population health. If members remain healthier for longer, everybody benefits. The challenge has never been understanding the value of prevention. The challenge has been determining how to invest in it effectively.

Value matters more than cost

One of the most thought-provoking parts of our discussion centred on willingness to pay.

Healthcare leaders often assume consumers are unwilling to spend money on preventative care. Angela’s experience suggests the reality is more nuanced.

People regularly invest in things they value. The question is rarely whether something costs money. The question is whether the outcome feels worthwhile.

That distinction matters because healthcare conversations often begin with affordability rather than value. Yet many successful healthcare businesses have demonstrated that consumers will invest when they clearly understand the benefit being created. The growth of digital health platforms, preventative health services and consumer-directed healthcare offerings all point in the same direction.

The lesson isn’t that cost doesn’t matter. It’s that value remains the more important part of the equation.

The GLP-1 opportunity and risk

No discussion about obesity management can avoid GLP-1 medications.

Angela’s perspective was balanced and refreshingly practical. She acknowledged their effectiveness and the role they can play in helping patients achieve meaningful weight loss. At the same time, she was careful not to position them as a complete solution.

Without changes to behaviour, nutrition and lifestyle, many patients regain weight once treatment stops. The medication may create an opportunity for change, but it doesn’t automatically create change itself.

That distinction feels increasingly important as public attention focuses on access to medication. New drugs will continue to emerge. Prices will eventually fall. Access will improve. The bigger question is whether those tools are being used to support long-term health improvement or simply deliver another cycle of short-term intervention.

When everyone agrees, why is change so slow?

As the conversation broadened beyond obesity, we found ourselves discussing incentives across the healthcare system.

Patients want to avoid chronic disease. Clinicians want healthier patients. Governments want lower healthcare costs. Insurers want fewer preventable claims and hospital admissions.

In many respects, the goals are already aligned.

So why does progress often feel slower than it should?

The question reminded me of a theme I explored in Everyone knows what to do. So why isn’t it happening? The challenge is rarely a lack of insight. Most leaders already understand the direction of travel. Prevention matters. Earlier intervention matters. Better use of data matters. More personalised healthcare matters.

The difficulty lies in execution.

Large systems move slowly. Funding models evolve gradually. Evidence takes time to accumulate. Organisations must balance today’s operational realities against tomorrow’s opportunities. Even when there is broad agreement about where the future is heading, translating that agreement into action can take years.

Innovation starts with a problem

Towards the end of our discussion, I asked Angela about her journey from clinician to entrepreneur.

Her answer was simple.

“I identified the problem and I created a solution.”

It’s advice that applies well beyond healthcare.

Many innovations begin with a technology, a product or a business idea. Only afterwards does the search begin for a customer problem that justifies its existence. The strongest innovations tend to work the other way around. They begin with a genuine problem, a deep understanding of the people experiencing it, and a desire to improve their situation.

Everything else follows from there.

It’s a principle that applies equally to healthcare providers, health insurers, technology companies and policymakers.

The prevention opportunity

Perhaps that’s why Angela’s opening observation stayed with me long after the conversation ended. Patients don’t want to go to hospital.

If we accept that premise, then prevention becomes much more than a public health aspiration. It becomes a strategic opportunity.

The organisations that create the greatest impact over the next decade are unlikely to be those that simply become more efficient at treating illness. They will be the organisations that find better ways to prevent it, delay it, or reduce its impact on people’s lives.

That trend is already emerging in the PHI Innovation Report, where many of Australia’s most innovative health insurers are investing more heavily in prevention, health management and early intervention. The approaches vary, but the direction is becoming increasingly clear.

The question is no longer whether prevention matters.

The question is how quickly we can build systems that make it easier.