There is an assumption quietly running through a large part of the healthcare investment community, one that rarely gets challenged, perhaps because it is so convenient. It goes something like this: “if you invest in a healthcare company, you are, by definition, doing something good for the world.”
Our own Pierpaolo wanted to challenge that, in an article first published on LinkedIn.
What climate VC figured out, and health VC hasn’t
Over the past five to ten years, a wave of European climate-focused VC funds quietly did something quite remarkable. Faced with the same problem that every thematic investor faces (namely an overwhelming universe of companies claiming to be relevant), they built the infrastructure to tell the difference: proprietary impact frameworks, sector-specific investment filters, theories of change mapped to measurable system outcomes, and impact-linked economics embedded not as a parallel process or a marketing layer, but as the actual architecture of investment decision-making.
The result is a generation of climate funds that can answer, with reasonable rigour, a question that should be basic but turns out to be hard: how exactly does this investment move the needle on the problem you say you care about?
Now look at European healthcare VC. The contrast is striking, and I think it stems from an assumption that climate investors never had the luxury of making: that the sector itself is the impact thesis. In climate VC, no one gets away with saying “we invest in clean energy, therefore we are impact investors.” The bar for demonstrating how, specifically, a given investment moves the needle on the problem has been high from the start. In health VC, that bar has rarely been applied with the same rigour, in part because investing in healthcare feels self-evidently good. The result: dedicated MedTech and HealthTech funds with a publicly disclosed, proprietary health impact framework remain rare in Europe, one that translates the complexity of healthcare systems into specific investment criteria, embeds impact thinking into screening, due diligence, and monitoring, and gives founders and investors alike a transparent view of how impact is evaluated.
The gap is remarkable, especially given that healthcare may be the sector where rigorous impact thinking matters most.
Scarcity, complexity, and the luxury we don’t have
Healthcare systems in Europe are under structural pressure that is not going away, driven by ageing populations, a chronic disease burden growing faster than clinical capacity, workforce shortages that no amount of incremental process improvement will solve, and cost trajectories that are simply not sustainable. These are not emerging risks; they are present realities, visible in every European health system today.
In that context, the allocation of capital is not a neutral act. Resources are scarce, and the problems are not. And not every investment made in healthcare is an investment that meaningfully addresses those problems.
The market is crowded with point solutions and incremental improvements that fail to influence system performance or deliver durable value: a new digital scheduling tool, a marginally better monitoring device, an AI application solving a convenience problem rather than a structural one. These are not bad companies, and many will generate returns, but they are not moving the needle on healthcare’s deep structural vulnerabilities, and we should not pretend otherwise.
The arrival of AI has made the distinction more acute, not less. Generalist capital, drawn by the scale of the opportunity, is flowing into healthcare at speed, often without the sector expertise to distinguish between innovations that address root causes and those that are simply riding a technology wave. When you don’t know the difference between a structural intervention and a marginal gain, you fund both equally, and healthcare systems, which need the former, end up with a lot more of the latter.
The question every health investor should be forced to answer is not “is this a healthcare company?” It is: which specific structural failure in the healthcare system does this company address, and how will you know if it worked?
The specialist’s compass is a public good
Here is the dynamic that makes this more than just an academic debate. In MedTech and HealthTech, generalist investors (increasingly interested in the sector, often genuinely well-intentioned) rely heavily on the signals sent by specialist VCs, whose conviction, thesis-fit assessment, and due diligence become the de facto reference point for the capital that follows. A specialist VC that leads a round is not just making one investment; it is, in effect, validating a signal that multiplies through the ecosystem.
That creates a responsibility.
If the expert investors in this sector (the ones with the clinical network, the regulatory fluency, the system-level understanding) do not integrate impact into their investment compass, the capital that follows them will not either. The multiplier effect works in both directions: it can scale impact, or it can scale noise.
This is why having a genuine impact framework in MedTech and HealthTech VC is not just a nice-to-have but a structural need. Commercial value and system value, when done right, are not in tension: the companies that improve patient outcomes, reduce cost burden, expand access, or address the workforce crisis are also the ones with the strongest adoption pull and the most durable market positions. A framework that makes this visible, that systematically evaluates not just market potential but system relevance, is not a constraint on returns. It is a sharper lens for finding them.
Words are cheap. Accountability is not.
Any fund can write an impact framework. The real question is whether it has consequences.
In climate VC, the leading funds have started answering that question with their economics, tying a meaningful portion of carried interest to the achievement of evidence-based impact targets, reviewed and approved by independent governance bodies, so that impact is not just claimed but defined, measured, and financially consequential.
In health VC, this level of accountability remains the exception rather than the rule, yet the stakes, in terms of system-level consequences, are arguably higher.
I believe we are still early. The infrastructure for rigorous, evidence-driven impact investing in healthcare is being built right now: the frameworks, the methodologies, the governance models. And the window to build it with genuine rigour, before “impact” becomes just another positioning layer in healthcare investment the way “ESG” did in public markets, is real but not unlimited.
The bar worth holding ourselves to is straightforward: impact in healthcare should be defined, not assumed; measured, not asserted, and when it does not materialise, there should be a consequence.
The time to demand that standard, from ourselves and from each other, is now.
