How do you align incentives in health-care between patient and hospital/HMO/PPO?

There's so much innovation to be done in health care, and I think a fundamental shift that needs to happen is to align economic incentives between customer and company.

Hospitals/HMO's/PPO's are incentivized to maximize transactions. Whether it's a monthly premium, drug purchase, visit, or a procedure. The more of these, the better. They also have a small incentive to keep the patient healthy, but only healthy enough to continue making these transactions. A patient, on the other hand, has the incentive to pay as little as possible to be healthy, to maximize personal happiness, productivity and longevity. What if a healthcare company's incentives were aligned with the patient? I've heard that in some health-care facilities in China a patient will pay a monthly fee when they are healthy, but if they get sick, they stop paying. What if something similar were done here?

A few of the problems to overcome if something like this were done:

1. Patients gaming the system - pretending to be sick so they don't have to pay premiums Potential solution: Create objective standards for what it means to be sick vs healthy. Have a patient submit to a quarterly blood test to have a full spectrum of different things tested, and then use results of blood test to define "sick."

2. Sickness/health is in many ways a lifestyle choice, so there's only so much a healthcare system can offer. If a person goes to a clinic where incentives are aligned, etc. but they go home and eat twinkies all day and sit in front of the TV, they will continue to get sick. Potential solution Mandate healthy diet/regular exercise as part of the program health-care program, and/or start out targeting the healthier part of the population.

I think this is a really interesting idea (the general idea of aligning incentives) for how to fix healthcare. Would really like to hear HN's thoughts on this.