# A Health Impact Fund pilot that pays for measured health gain instead of price

Source: https://onco.cc/ideas/idea-fund-health-impact-fund-oncology/  
OnCo record `idea-fund-health-impact-fund-oncology` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Companies could choose to sell a new cancer drug at cost worldwide and instead be paid from a pooled fund according to how much health it actually delivers.

## Summary

The Health Impact Fund proposal: an optional, government-financed pool that pays registered products annually for ten years in proportion to their measured health impact (quality-adjusted life years gained across all countries), on condition that the product is sold at the cost of manufacture everywhere. For oncology this rewards drugs that deliver large gains to many patients, including in low-income countries, rather than drugs that extract high prices from few. An oncology-only pilot with a few billion dollars and two or three products would test measurement feasibility and industry appetite.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: In a pilot, at least two oncology products register, health impact can be measured with acceptable uncertainty using registry and sales data, and registered products reach patients in low- and middle-income countries at volumes an order of magnitude above comparable priced products.
- Rationale: The proposal has been developed in detail by economists and philosophers over fifteen years and is endorsed by several Nobel laureates; the pieces (impact measurement, cost-of-goods auditing, tiered access) exist separately. Oncology has strong outcome data and stark access inequalities, making it a fair test.
- Proposed test: A government-philanthropy consortium funds a five-year pilot with a small number of products and pre-registered impact measurement methodology; success is completed measurement, access volumes and industry willingness to register further products.
- Maturity: speculative
- Actor: policy

## Sources

- Health Impact Fund: https://healthimpactfund.org/

## Connected records

- ideas: [Transferable priority vouchers for first-in-class drugs, with price conditions](https://onco.cc/ideas/idea-fund-conditional-transferable-voucher/), [University licences with royalties indexed to benefit and global access](https://onco.cc/ideas/idea-fund-global-access-licensing-royalties/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)

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