First wave
Move-to-Earn
Paid for step counts verified by an accelerometer — spoofed by a phone taped to a fan. Rewards were emissions funded by new buyers; several networks lost over 95% of active users within twelve months of peak.
02Market failure
Prevention produces an absence. Budgets pay invoices.
A stroke that did not happen generates no claim. The household actions that averted it happen outside any institutional line of sight — and capital does not flow to inputs it cannot audit.
2.1 · The global curative misallocation
82–88%of global health capital sits in end-stage clinical intervention — admissions, procedures, treatment of established disease.
A ratio that has held for two decades
Primary prevention, early detection and adherence support share what remains. The split has been stable across mature and high-growth economies, through expansions and austerity, under single-payer and multi-payer systems alike. Its persistence points to a structural cause, not a policy oversight.
The cause is observability. A procedure happens at a known place and time, performed by a licensed party who submits a coded claim. A finance ministry can model the savings of prevention, but it cannot audit the inputs.
The result compounds in national accounts: health spending grows faster than GDP, concentrated in non-communicable disease — exactly where early action has the highest modeled return and the lowest actual funding.
2.2 · The equatorial metabolic cliff
An epidemiological transition in a single generation
Urbanization, a dietary shift toward refined carbohydrates and processed fats, and a collapse in occupational activity have reshaped health in high-density tropical and archipelagic corridors.
11–12%adult type-2 diabetes prevalence in one representative corridor, up from 10–11%
~16%modeled diabetes trajectory by mid-century
1 in 3adults living with hypertension — and more
19–20%of children under five still affected by stunting
A health system managing malnutrition in one generation and metabolic excess in the next is managing both at once — often in the same household.
Specialists concentrate in tier-1 metropolises while hospital beds per capita in outlying regions run at a fraction of the national mean. Near-universal nominal coverage means the fiscal exposure is fully socialized: when a remote diabetic reaches end-stage renal disease, the statutory fund pays for dialysis, transport and lost productivity.
Fund leadership has said it cannot sustain that trajectory on curative reimbursement alone, and has begun shifting contracts toward value-based payment. That shift is the opening — a payer that reimburses on outcomes needs to see them, and the outcomes that matter most are produced at home.
2.3 · The detection-to-action chasm
Screening works. What follows it breaks.
Mass campaigns now reach tens of millions of adults a year. Yet without structured reinforcement, adherence to a preventive regimen decays to roughly 6–10% by day 180.
Modeled cohort · 100,000 screened adults, tracked to day 180
Screened
100,000
Flagged for follow-upMajority asymptomatic
22,000
Returned for confirmationDistance · cost · working hours
9,500
Initiated a regimenNo perceived benefit
6,200
Adherent at day 90No reinforcement
2,800
Adherent at day 180Caregiver blind spot
1,800
ModeledBaseline decay drawn from post-screening adherence literature. In one national campaign, fewer than 3–4% of newly identified patients reached controlled status within the follow-up window.
Four coordination failures — none solved by better screening
01
The condition is silent
Asymptomatic disease means no felt cost from skipping treatment and no felt benefit from following it.
02
Follow-up is expensive
The facility may be hours away, open during working hours, reached at the patient's own expense.
03
The clinician is blind
Whoever delivered the diagnosis cannot know whether the patient returned, and is not paid either way.
04
Family has no view
The relatives who could reinforce the regimen have no visibility into it.
2.4 · Structural failure of Web3 precedents
Health coordination has been tried. The failures are instructive.
Platforms
Centralized telehealth
Good businesses, but the platform both records adherence and profits from the data, so no outside payer can treat its logs as verification. Patient data sits in a silo that breaches periodically.
Employers
Corporate wellness
Self-reported or vendor-verified participation, high fraud rates, and uptake skewed toward people who were already healthy — capital flows away from where cost avoidance is largest.
| Model | Payer money at risk | Verifier capital at risk | Trust without seeing data |
|---|---|---|---|
| Move-to-Earn | No | No | No |
| Centralized telehealth | No | No | No |
| Corporate wellness | Yes | No | No |
| Larasguna | Yes | Yes | Yes |
3 / 3
Each precedent lacks at least one of three things. A payer whose money is at risk, a verifier whose capital is at risk, or a data architecture that lets a third party trust the verification without seeing the data. Larasguna requires all three.