Daniel Ek was right about healthcare

The music guy who started measuring bodies#

Daniel Ek built Spotify. That is the bit everyone knows. The bit that matters now is what he did with the pattern recognition that made Spotify work.

In 2018 he sat down with Hjalmar Nilsonne and asked a question that sounds like a thought experiment until you notice nobody in power was answering it: if there were no healthcare system, and we had to design one today, what would it look like?

Their answer was not another hospital, another app that nags you to walk 10,000 steps, or another insurer package with a wellness discount. It was a system built around people who still feel fine. Catch the signal before the crisis. Collect the data while it is still cheap to act on. Give a clinician time to talk.

That company is Neko Health. First clinic in Stockholm in 2023. London, Manchester, Birmingham. US expansion underway, with Ek recently walking through the New York launch on All-In. The product is a roughly hour-long, radiation-free scan: skin imaging, cardiovascular checks, on-site blood markers, body composition that goes beyond BMI, then a face-to-face clinician review before you leave. In the US they are pitching it around $499 a year.

I think he is right. Not because a Spotify founder saying "prevention" is fashionable. Because the diagnosis of the broken system is sharper than most policy white papers, and the early data from his own clinics is starting to look like more than a marketing deck.

This is not medical advice, and it is not a Neko advert. It is an argument about incentives, data, and why waiting for symptoms is a stupid way to run a civilisation that already knows most of the killers are chronic and slow.

The industry was never designed for chronic disease#

Ek's framing on All-In is the cleanest version of the point. The US spends around 18% of GDP on healthcare. Heart disease alone is a budget line that would embarrass a Fortune 10 revenue chart. Everyone agrees the machine should move from reactive to preventive. Then the agreement collapses the moment you ask how.

Neko's own packaging of the numbers is blunt enough to keep: about 80% of healthcare budgets go into managing chronic disease, while prevention itself gets under 1%. Cardiovascular disease and type 2 diabetes are among the big cost drivers, and large shares of both are treated as preventable if you catch the trajectory early enough. The World Economic Forum and others have been warning for years that non-communicable disease is an economy-scale problem, not a lifestyle lecture.

The system is not failing at the job it was built for. It was built to triage infection, trauma, and acute crisis. It is excellent at that. Then the burden shifted to decades-long metabolic and cardiovascular decline, and the operating model never really changed. You still mostly turn up when something hurts, or when something has already failed loudly enough that a hospital has to catch it.

I have lived a quieter version of that design. Depressed from 11 into my thirties. Assessed, listened to, prescribed for. In twenty years nobody took my blood. When someone finally did, my testosterone was on the floor. Altering brain chemistry was easy. Looking for a measurable physical contributor was somehow exotic. That is what a reactive system does: it optimises for the intervention it can start today, and quietly demotes the slower question of why this body.

Ek's version of that complaint is at population scale. If you discover chronic disease early, the cost and the suffering collapse. If you discover it late, you buy stents, dialysis, oncology pathways, and years of diminished life. The disagreement is not philosophical. It is about whether anyone will pay to look before the bill arrives.

Broken incentives beat good intentions#

This is where Ek stops sounding like a wellness founder and starts sounding like someone who has read the balance sheet.

In the US, coverage is usually tied to employment. Average tenure is short. Switch jobs, switch insurers. Prevention that pays off in ten or twenty years is a gift to a future payer, often Medicare. The insurer who would write the cheque today never captures the return. So prevention is treated as a cost centre, and acute treatment remains the thing the system knows how to invoice.

That is not a conspiracy. It is a rational response to a stupid horizon.

Europe is not magically better because we have public systems. The NHS still runs on crisis capacity, waiting lists, and ten-minute appointments. Prevention exists as slogans, screening programmes for a few cancers, and public health campaigns that compete with every other budget pressure. The structural bias is the same even when the payer is the state: the acute case is urgent and visible; the silent trajectory is optional.

Ek's bet is that the missing piece is not another lecture about vegetables. It is data dense enough, cheap enough, and repeated often enough that early detection becomes operationally boring. Multimodal. Longitudinal. Blood plus skin plus heart plus composition, year after year, so change is visible before symptoms invent a story about it.

Spotify's playbook shows up here too. Build in Sweden. Prove the product. Expand to the UK. Only then take the US. Same geographic patience as music streaming. Same refusal to ship a half-finished consumer product into the hardest market first.

What the year-three data actually shows#

Company data is company data. Say that out loud before you get excited. No control group. Self-selected members who can afford a preventive scan and are motivated enough to book one. Self-reported behaviour change. Neko themselves flag all of that in the Year Three Data Story.

Even with those caveats, the pattern is awkward for the "worried well" dismissal.

Across more than 80,000 members in the UK and Sweden, returning members with two scans improved across the seven cardiometabolic markers Neko tracked: blood pressure, cholesterol measures, HbA1c, weight, grip strength. Heart age, built on the NHS-familiar QRISK3 model, rose by roughly nine months over a year of calendar time. Members who already knew they had blood pressure, cholesterol, or diabetes problems improved more than the rest, but the "no prior diagnosis" group still moved in the right direction.

The scary end of the distribution is the part that sticks. In Sweden, around 1% of members in the reported age band had a severe, potentially life-threatening condition found while asymptomatic: invasive melanoma, serious arrhythmias, significant valve disease, aortic aneurysms. That rate held roughly steady as volumes tripled across 2023 to 2025. Another few percent had significant conditions needing treatment, or early signs that could become chronic if ignored.

On All-In, Ek put the scan tally north of 100,000 and kept citing that same roughly 1% serious-find rate. If even a fraction of those people would otherwise have discovered the problem at a heart attack, a late melanoma, or a collapsed valve, the product thesis is not "rich people like gadgets." It is "silent disease is common enough that waiting for symptoms is malpractice at scale."

Behaviour change in the returning cohort is softer evidence, but directionally consistent: a chunk of smokers quit between scans; people who said they exercised more lost more weight; medication explained only part of the blood-pressure and cholesterol improvements. People act differently when they can see their own numbers and sit with a clinician who has time.

Is that proof that Neko will bend national healthcare costs? No. Ek has been honest that population-level savings are still unproven. Is it enough to say the founding bet is directionally right? Yes.

Why this lands for me#

I do not need a Swedish billionaire to tell me the system waits too long. I needed a private clinic and my own money to get the blood panel the public pathway never ordered. Peptides, hormones, metabolic markers, skin checks, heart risk: the culture is waking up to the idea that "feel fine" is not the same as "are fine," and that annual contact with your own data beats a once-a-decade crisis.

What Ek adds is the systems argument. Prevention fails when nobody owns the long horizon. It fails when clinicians have no time. It fails when the only rich dataset you have is the one collected after someone is already in secondary care. Vertical integration is controversial in healthcare for good reasons, but the Neko version of it is at least coherent: own the sensors, the clinic flow, the software, and the clinician minutes, then drive the unit cost of a serious look at a body down until annual screening stops sounding luxury.

The uncomfortable second half of the story is access. Oxford Scientist put it cleanly: without public subsidy, insurance integration, or primary-care redesign, this future belongs first to the already healthy, affluent, and health-literate. False positives, anxiety, and unnecessary follow-ups are real risks in any screening product. A £299 or $499 scan that finds disease early for people who can pay is still a two-tier answer unless the model bleeds into the systems that treat everyone else.

That does not make Ek wrong. It makes the next fight obvious. If the data keeps looking like year three, the question stops being "is prevention a vibe?" and becomes "why is the public system still organised as if chronic disease is a surprise?"

He was right about the diagnosis#

Spotify did not invent music. It changed the distribution and the incentive geometry until piracy stopped being the rational consumer choice. Neko will not invent medicine. The bet is that if you change the measurement geometry — cheap, repeated, multimodal, clinician-backed — the rational choice stops being "wait until it hurts."

Daniel Ek was right that healthcare is structurally reactive. He was right that chronic disease is where the money and the misery concentrate. He was right that better longitudinal data is the precondition for anything that calls itself prevention with a straight face. And the early Neko numbers, imperfect as they are, look like a company shipping that thesis rather than keynoting it.

Whether that becomes infrastructure or remains a premium product is the unfinished part. The direction is not.

References#

• Neko Health — About
• Neko Health Data Story: Year Three
• Daniel Ek on All-In — transcript highlights
• Broken incentives summary of the All-In healthcare segment
• The Oxford Scientist — Neko Health and the future of preventive healthcare
• Earlier post: depression, SSRIs, and low testosterone