The Prevention Paradox: why Canadian employers pay for treatment instead of prevention

"One of the most heartbreaking things that I find I deal with in the emergency room is mental health, we cannot do the things that we need to do or get them to the care that we need to get to."

Hayley Wickenheiser - former Olympian (four time gold medalist for Team Canada Hockey) and current emergency physician was describing the hardest part  in her work. Not sudden cases, but ones where someone has been struggling for months or years. By the time the system finally meets them at 2am, it’s already too late. 

She was in conversation with Jean-Charles Samuelian-Werve, Alan's co-founder and CEO, for an invite-only evening in Toronto in July 2026 built around “prevention insurance”, a new category Alan is pioneering.

The prevention paradox is the gap between agreement and funding. Almost everyone accepts that preventing illness costs less than treating it. Almost nothing in the healthcare system is built or paid for on that basis. The money arrives at the point of crisis, in the emergency room, which is the most expensive and least effective place to intervene.

A single question came up during Q&A that put the problem on both speakers directly. Crisis money is easy to find, while prevention money is not: If everyone agrees prevention is better, why does almost nothing get built for it?

Emergency medicine is not broken. It is absorbing every problem that should have been treated earlier and never was. 

Wickenheiser estimates the major centre where she works sees around 200 patients a day. Redirecting 50-60 of them to somewhere more appropriate would save the system billions, and would leave the emergency department for people who genuinely need it. The numbers justify her concern: A CMAJ study published the day of the event found that one in ten Canadian emergency physicians have left the specialty, and nearly half have cut their clinical hours. 

Wickenheiser described the feeling on a given shift as being one disaster away from a disaster, and said the system as it stands is not sustainable.

Samuelian-Werve sees the real opening somewhere else. Rather than waiting for policy to create the conditions for prevention, build the model first and let the evidence make the case."You need to make the work and not wait for the policy to come, you need to show a use case. We need to make it almost like it's already manufactured."

His argument is that policy rarely leads. It moves when there's already outcomes to point at - a model that exists and has shown success. Without it, prevention stays an idea that everyone endorses and no one funds. He noted that in geographies where Alan has operated longer, the proof points on prevention at scale are what generate the debate in the first place.

If policy moves slowly the question becomes where you can make an impact. Samuelian-Werve's answer was employers.

"I would also start with what we can control, every single employer can start shifting their mindset a little bit… when society starts pushing a message, politicians end up reacting a bit more."

Employers reach people continuously, before anything has gone wrong, and without making them navigate a system to get there.. That makes the workplace one of the few places where prevention can be implemented at a scale which causes actual change.

It is also the place where the cost of not doing it shows up first, in claims, in absenteeism, and at renewal.

Prevention insurance is the category Alan is building. It treats insurance, care and prevention as one product rather than three, and it is measured by what does not happen: the emergency room visit avoided, the condition caught early, the claim never filed.

Most benefits stacks are not broken because companies are not trying, but rather because five or six disconnected tools cannot add up to one strategy.

The evening did not produce a policy answer, and nobody in the room expected one. What it produced was a narrower and more useful question for the people who employ others: what is the current setup costing, and what would it take to change it before the bill arrives in an emergency department at 2am.