Prevention is underfunded partly by budget boundary rather than by disbelief in it: the WEF report states that prevention costs fall on the national healthcare budget while much of the benefit accrues to the social insurance budget as savings on unemployment and disability payments, and that patient churn between multiple payers further weakens any single payer's incentive to invest.

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One reason health systems have difficulty focusing on prevention is that many of the costs come out of the national healthcare budget, whereas many of the benefits accrue to the national social insurance budget as savings on, for example, unemployment benefits and disability payments that result from a healthier workforce. Because public agencies or government bodies in most nations are not taking a holistic view of the full cycle of care, systems fail to make the trade-offs necessary to improve value in health. The problem is exacerbated by patient churn in health systems that feature multiple payers, given patients' tendency to move from one insurer to another over time. If an individual payer is unlikely to reap the benefit of prevention because patients move on to other insurers, why invest in it in the first place?