Why the hospital of the future will be your own home | Niels van Namen

81,681 views ・ 2018-10-10

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00:13
Probably not a surprise to you,
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but I don't like to be in a hospital
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or go to a hospital.
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Do you?
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I'm sure many of you feel the same way, right?
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But why? Why is it that we hate hospitals so much?
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Or is it just a fact of life we have to live with?
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Is it the crappy food?
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Is it the expensive parking?
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Is it the intense smell?
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Or is it the fear of the unknown?
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Well, it's all of that, and it's more.
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Patients often have to travel long distances
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to get to their nearest hospital,
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and access to hospital care is becoming more and more an issue
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in rural areas,
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in the US,
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but also in sparsely populated countries like Sweden.
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And even when hospitals are more abundant,
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typically the poor and the elderly
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have trouble getting care because they lack transportation
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that is convenient and affordable to them.
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And many people are avoiding hospital care altogether,
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and they miss getting proper treatment
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due to cost.
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We see that 64 percent of Americans
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are avoiding care due to cost.
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And even when you do get treatment,
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hospitals often make us sicker.
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Medical errors are reported to be the third cause of death in the US,
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just behind cancer and heart disease,
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the third cause of death.
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I'm in health care for over 20 years now,
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and I witness every day how broken and how obsolete our hospital system is.
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Let me give you two examples.
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Four in 10 Japanese medical doctors
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and five in 10 American medical doctors
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are burnt out.
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In my home country, the Netherlands,
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only 17 million people live there.
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We are short 125,000 nurses over the coming years.
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But how did we even end up here,
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in this idea of placing all kinds of sick people
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together in one big building?
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Well, we have to go back to the Ancient Greeks.
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In 400 BC, temples for cure were erected
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where people could go to get their diagnosis,
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their treatment and their healing.
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And then really for about 2,000 years,
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we've seen religious care centers
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all the way up to the Industrial Revolution,
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where we've seen hospitals being set up as assembly lines
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based on the principles of the Industrial Revolution,
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to produce efficiently
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and get the products, the patients in this case,
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out of the hospital as soon as possible.
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Over the last century, we've seen lots of interesting innovations.
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We figured out how to make insulin.
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We invented pacemakers and X-ray,
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and we even came into this wonderful new era of cell and gene therapies.
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But the biggest change to fix our hospital system altogether
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is still ahead of us.
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And I believe it's time now, we have the opportunity,
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to revolutionize the system altogether
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and forget about our current hospital system.
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I believe it's time to create a new system
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that revolves around health care at home.
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Recent research has shown
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that 46 percent of hospital care
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can move to the patient's home.
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That's a lot.
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And that's mainly for those patients who suffer from chronic diseases.
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With that, hospitals can and should
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reduce to smaller, agile and mobile care centers
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focused on acute care.
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So things like neonatology, intensive care, surgery and imaging
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will still remain at the hospitals,
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at least I believe for the foreseeable future.
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A few weeks ago, I met a colleague
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whose mom was diagnosed with incurable cancer,
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and she said, "Niels, it's hard.
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It's so hard when we know that she's got only months to live.
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Instead of playing with the grandchildren,
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she now has to travel three times a week
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two hours up and down to Amsterdam
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just to get her treatment and tests."
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And that really breaks my heart,
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because we all know that a professional nurse
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could draw her blood at home as well, right?
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And if she could get her tests and treatment at home as well,
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she could do the things that are really important to her
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in her last months.
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My own mom, 82 years old now -- God bless her --
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she's avoiding to go to the hospital
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because she finds it difficult to plan and manage the journey.
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So my sisters and I, we help her out.
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But there's many elderly people who are avoiding care
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and are waiting that long that it becomes life-threatening,
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and it's straight to the costly, intensive care.
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Dr. Covinsky, a clinical researcher at the University of California,
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he concludes that a third of patients over 70
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and more than half of patients over 85,
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leave the hospital more disabled than when they came in.
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And a very practical problem
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that many patients face when they have to go to a hospital is:
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Where do I go with my main companion in life,
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where do I go with my dog?
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That's our dog, by the way. Isn't she cute?
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(Laughter)
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But it's not only about convenience.
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It's also about unnecessary health care stays and costs.
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A friend of mine, Art,
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he recently needed to be hospitalized for just a minor surgery,
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and he had to stay in the hospital for over two weeks,
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just because he needed a specific kind of IV antibiotics.
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So he occupied a bed for two weeks
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that cost over a thousand euros a day.
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It's just ridiculous.
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And these costs are really at the heart of the issue.
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So we've seen over many of our global economies,
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health care expense grow as a percentage of GDP
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over the last years.
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So here we see that over the last 50 years,
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health care expense has grown from about five percent in Germany
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to about 11 percent now.
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In the US, we've seen growth from six percent to over 17 percent now.
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And a large portion of these costs are driven by investments
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in large, shiny hospital buildings.
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And these buildings are not flexible,
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and they maintain a system where hospital beds need to be filled
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for a hospital to run efficiently.
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There's no incentive for a hospital to run with less beds.
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Just the thought of that makes you sick, right?
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And here's the thing: the cost for treating my buddy Art at home
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can be up to 10 times cheaper than hospital care.
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And that is where we're headed.
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The hospital bed of the future will be in our own homes.
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And it's already starting.
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Global home care is growing 10 percent year over year.
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And from my own experience, I see that logistics and technology
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are making these home health care solutions work.
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Technology is already allowing us to do things
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that were once exclusive to hospitals.
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Diagnosis tests like blood,
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glucose tests, urine tests, can now be taken in the comfort of our homes.
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And more and more connected devices
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we see like pacemakers and insulin pumps
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that will proactively signal if help is needed soon.
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And all that technology is coming together
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in much more insights into the patients' health,
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and that insight and all of the information leads to better control
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and to less medical errors --
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remember, the third cause of death
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in the US.
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And I see it every day at work.
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I work in logistics
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and for me, home health care works.
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So we see a delivery driver deliver the medicine
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to the patient's home.
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A nurse joins him and actually administers the drug
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at the patient's home.
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It's that simple.
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Remember my buddy, Art?
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He can now get the IV antibiotics in the comfort of his home:
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no hospital pajamas, no crappy food
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and no risk of these antibiotic-resistant superbugs
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that only bite you in these hospitals.
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And it goes further.
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So now the elderly people can get the treatment that they need
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in the comfort of their own home
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while with their best companion in life.
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And there's no need anymore to drive hours and hours
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just to get your treatment and tests.
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In the Netherlands and in Denmark,
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we've seen very good successes in cancer clinics
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organizing chemotherapies at the patient's homes,
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sometimes even together with fellow patients.
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The best improvements for these patients
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have been improvements in reduction in stress,
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anxiety disorders and depression.
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Home health care also helped them to get back a sense of normality
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and freedom in their lives,
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and they've actually helped them to forget about their disease.
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But home health care, Niels --
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what if I don't even have a home, when I'm homeless,
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or when I do have a home but there's no one to take care of me
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or even open up the door?
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Well, in comes our sharing economy,
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or, as I like to call it, the Airbnb for home care.
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In the Netherlands, we see churches and care organizations
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match people in need of care and company
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with people who actually have a home for them
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and can provide care and company to them.
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Home health care is cheaper,
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it's easier to facilitate, and it's quick to set up --
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in these rural areas we talked about, but also in humanitarian crisis situations
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where it's often safer, quicker and cheaper to set things up at home.
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Home health care is very applicable in prosperous areas
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but also very much in underserved communities.
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Home health care works in developed countries
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as well as in developing countries.
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So I'm passionate to help facilitate improvements in patients' lives
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due to home health care.
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I'm passionate to help facilitate
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that the elderly people get the treatment that they need
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in the comfort of their own homes,
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together with their best companion in life.
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I'm passionate to make the change
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and help ensure that patients, and not their disease,
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are in control of their lives.
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To me, that is health care delivered at home.
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Thank you.
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(Applause)
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