Healthcare is notoriously slow with adoption of new technology. IMO this is because healthcare is fee-for-service, which is basically incompatible with prevention. A movement to value-based care would vastly improve adoption of preventive and personalized healthcare.

The HMO model was basically designed to bring in an element of value-based reimbursement. For example, the CMS capitation payments to Medicare Advantage plans are weighted by (inter alia) health outcomes.

OK that explains a few countries which have a fee-for-service model, what about those countries incentivized to prevent problems? Do they take new technology on faster?

Austria has a single payer system but each part of that system still charges via fee for service.

Innovation does not get injected top down by the omniscient insurance system but bottom up from research clinics and forward thinking doctors.

People engaging the insurance directly with an efficiency play almost always fail here. There are even some vaccines against transmissible diseases that you have to pay for as an adult. I always wonder how that can make any sense. Either the value of delivering the vaccine is less than the 10 euros they are charging me (which probably means it is not very important for me to get it) or the insurance makes a colossal mistake. Especially since most vaccines are only individually unimportant since everyone else has them.

how can people take action themselves here

As naive as it may sound, start your own little health care facility, with physicians and individuals who see the problems that plague mainstream. The facility can be either be a secret or out in the sea, outside the jurisdiction of most governments. The rot in mainstream medicine (as with some other aspects of life) is so deep and entrenched that no amount of attempting to fix it by individuals (or even groups) will work.

I guess creating startups that offer polished ctDNA solutions or pressing local governments to make healthcare more streamlined, perhaps even with healthcare IT startups too.

The problem is that most healthcare systems are too fragmented and not geared towards prevention. Hence, one faces a huge uphill battle.

Is this something private labs offer?

Yes, and it's not very expensive. Many EU & US labs would do a test for you for ~$300--$500.

I guess it'd be really cheap if it was deployed nationwide. Furthermore, predictions would be a lot more sensitive / specific as they would be tuned with millions of datapoints.

It's the same for other technologies such as TCR-seq. They could theoretically bring immense prevention benefits, but it's really hard to bootstrap them without collaboration from big healthcare systems as you need thousands of datapoints to get it going. Very frustrating.

Would there be an opportunity to advertise this online and provide an end-to-end service of testing on an interval basis to customers? Subsidized by VC money on the promise of valuable data sets for this sensitivity/specificity in the long term?

I truly think so. The real hurdle is to get into a collaboration with a reasonably organized healthcare provider that lets you access a sufficiently large pool of donors, with electronic health records and the capability to follow them up.

Bonus points if you can genotype them, i.e. measure common genetic variants using a chip similar to e.g. the one used by 23andme. Most tumors have an association with variants in the HLA region, and pre-screening susceptible individuals will reduce sample sizes and therefore initial costs to bootstrap.

The same applies to TCR-seq and other biomarkers which are incredibly useful to detect autoimmune disorders really early in the process.

In case you are interested in discussing this further, just get in touch via email (on my profile).