A family office might know exactly where a family’s assets are held, how ownership is structured and what should happen when wealth passes to the next generation. Ask where a family member’s complete medical history is held, however, and the answer may be far less certain.
It is an odd imbalance. Families devote considerable resources to protecting their financial position, yet healthcare is often dealt with as a series of separate events: a specialist appointment here, a scan there, an insurance renewal once a year.
That is beginning to change. Some family offices are applying the same discipline to health that they have traditionally applied to wealth.
A family office for your health?
The idea of a medical family office is relatively new, but the thinking behind it is straightforward. Instead of leaving individuals to coordinate doctors, medical records, preventive screening and insurance themselves, these functions are brought together.
SIP Medical Family Office, featured recently on the Family Office Stories podcast, bases its approach on four areas: medical records management, prevention, privileged access to healthcare, and international private medical insurance.
For globally mobile families, coordination can become particularly important. Someone may live in South Africa, spend several months of the year overseas and have children living on different continents. If serious treatment is needed, the preferred specialist or hospital may not even be in the country where that person lives.
At that point, good healthcare involves more than having sufficient medical cover. The pieces need to work together.
The file nobody wants to find in a hurry
Consider something as mundane as medical records.
Over decades, a person may accumulate scans, blood tests, pathology reports, prescriptions and specialist assessments across numerous practices and hospitals. Much of that information exists somewhere. The difficulty is finding it when it is suddenly important.
That matters when a new doctor is trying to understand a complicated medical history, particularly if the patient is ill, travelling or unable to provide the details personally. A consolidated record can reduce unnecessary repetition and give treating specialists a better starting point.
There is a useful parallel with financial planning here. Few advisers would willingly make an investment recommendation after seeing only fragments of a client’s portfolio. Yet patients routinely arrive in consulting rooms with fragments of their medical histories.
Information does not guarantee a better outcome. Incomplete information, however, can make good decisions harder.
The expensive promise of living longer
The growing fascination with longevity adds another dimension.
There is now a sizeable industry built around extending not merely lifespan, but “healthspan” – the years during which people remain healthy and independent. Genetic testing, advanced imaging, continuous monitoring, biological-age tests and personalised programmes are increasingly being marketed to people who can afford them.
Some of this is grounded in established preventive medicine. Some is promising but still developing. And some comes wrapped in more confidence than the evidence warrants.
That creates an unusual problem for wealthy families. Money removes many barriers to healthcare, but it also provides access to interventions that may be expensive long before they are proven to be useful.
The answer is not to dismiss longevity science. Nor is it to embrace every new test or treatment. It is to have sufficiently independent medical advice to know the difference between sensible prevention, an emerging possibility and a persuasive sales pitch.
When the person in charge can no longer be in charge
There is another reason health belongs on the family-office agenda, and it has little to do with medical insurance.
Dementia and Alzheimer’s disease raise difficult questions for any family. Where significant wealth, trusts or operating businesses are involved, they can also expose weaknesses in governance.
Imagine a founder who remains the dominant voice in a family enterprise well into later life. He or she may still approve major transactions, sit on trustee boards and influence investment decisions. Cognitive deterioration is rarely as convenient as a formal retirement date. It may be gradual, disputed within the family and difficult to acknowledge.
That is when questions that once seemed theoretical become urgent. Who can act if the founder loses decision-making capacity? Are the relevant mandates and legal arrangements already in place? Who decides when responsibilities should pass to somebody else? And has the family ever discussed what the founder would want?
Planning for incapacity while everyone is well may feel unnecessarily pessimistic. Waiting until capacity is in doubt is considerably harder.
This is where healthcare, estate planning and family governance begin to overlap. Succession planning usually asks what happens when somebody dies or retires. Increasing longevity suggests it should also ask what happens if someone remains alive for many years but can no longer fulfil the role around which the family’s affairs were built.
Perhaps health is part of the balance sheet after all
A medical family office will not be necessary for every wealthy family. The underlying principle is more widely relevant: health deserves to be organised rather than merely reacted to.
That could mean something as simple as keeping complete medical records in one accessible place, reviewing whether international medical insurance still suits the family, taking preventive screening seriously and agreeing in advance how incapacity would be handled.
There is also a broader point. Wealth is accumulated partly because of what we hope it will give us later: independence, freedom, time with family and the ability to choose how we live.
Those benefits become considerably less valuable if poor health removes the ability to enjoy them.
Perhaps that is why healthcare is finding its way onto the family-office agenda. Protecting wealth matters. Protecting the person who is meant to use it matters just as much.