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

譯者: Lilian Chiu 審譯者: Helen Chang

Probably not a surprise to you,

各位可能不會覺得意外，

but I don't like to be in a hospital

我並不喜歡待在醫院裡，

or go to a hospital.

也不喜歡去醫院。

Do you?

你們呢？

I'm sure many of you feel the same way, right?

我相信許多人都有同感，對吧？

But why? Why is it that we hate hospitals so much?

但，為什麼？我們 為什麼這麼討厭醫院？

Or is it just a fact of life we have to live with?

還是這就只是個人生的 事實，我們得要接受？

Is it the crappy food?

問題在於醫院食物很爛嗎？

Is it the expensive parking?

還是停車費太貴？

Is it the intense smell?

還是那種很強烈的氣味？

Or is it the fear of the unknown?

或是對於未知的恐懼？

Well, it's all of that, and it's more.

嗯，以上全部都是，且還有別的。

Patients often have to travel long distances

病人通常都需要跑很遠的一段路

to get to their nearest hospital,

才能到最近的醫院，

and access to hospital care is becoming more and more an issue

而取得醫院照護 漸漸變成了一個議題，

in rural areas,

在郊區是如此，

in the US,

在美國是如此，

but also in sparsely populated countries like Sweden.

在人口很分散的國家 如瑞典亦是如此。

And even when hospitals are more abundant,

即使是在醫院很充足的情況下，

typically the poor and the elderly

通常，窮人和老人

have trouble getting care because they lack transportation

也不容易取得照護，因為他們缺乏

方便且能夠負擔得起的交通工具。

that is convenient and affordable to them.

And many people are avoiding hospital care altogether,

許多人就甘脆直接避免醫院照護了，

and they miss getting proper treatment

他們錯過了取得適當治療的機會，

due to cost.

只因為成本考量。

We see that 64 percent of Americans

有 64% 的美國人

are avoiding care due to cost.

因為成本因素而避開照護。

And even when you do get treatment,

即使當你真的接受治療時，

hospitals often make us sicker.

醫院通常也會讓我們病得更重。

Medical errors are reported to be the third cause of death in the US,

根據報告，在美國 排名第三的死因是醫療疏失，

just behind cancer and heart disease,

只輸給癌症和心臟疾病。

the third cause of death.

排名第三的死因。

I'm in health care for over 20 years now,

我已經做健康照護二十多年了，

and I witness every day how broken and how obsolete our hospital system is.

每天，我都會目擊我們的 醫院體制有多糟糕、多過時。

Let me give you two examples.

讓我舉兩個例子來說明。

Four in 10 Japanese medical doctors

十個日本醫生當中有四個，

and five in 10 American medical doctors

十個美國醫生當中有五個，

are burnt out.

都累到筋疲力竭。

In my home country, the Netherlands,

在我的祖國，荷蘭，

only 17 million people live there.

居民只有 1700 萬人。

We are short 125,000 nurses over the coming years.

在接下來的幾年， 我們會缺 12 萬 5 千名護士。

But how did we even end up here,

但我們是怎麼落到這個地步的？

in this idea of placing all kinds of sick people

把各種生病的人 全都送到一棟大樓裡，

together in one big building?

這個想法是哪來的？

Well, we have to go back to the Ancient Greeks.

這就得追溯回古希臘時代了。

In 400 BC, temples for cure were erected

西元前 400 年，建立了治療所，

where people could go to get their diagnosis,

人們可以去治療所取得診斷、

their treatment and their healing.

接受治療，並被治癒。

And then really for about 2,000 years,

接下來的大約 2000 年，

we've seen religious care centers

我們看到了宗教照護中心，

all the way up to the Industrial Revolution,

一直到工業革命，

where we've seen hospitals being set up as assembly lines

那時是用裝配線的方式設立醫院，

based on the principles of the Industrial Revolution,

依據的就是工業革命的原則，

to produce efficiently

以增加生產效能，

and get the products, the patients in this case,

並讓產品——用在醫院時， 產品就是指病人——

out of the hospital as soon as possible.

盡快從醫院出來。

Over the last century, we've seen lots of interesting innovations.

在過去一個世紀， 我們看到了許多有趣的創新。

We figured out how to make insulin.

我們找到方法來製造胰島素。

We invented pacemakers and X-ray,

我們發明了心律調節器和 X 光，

and we even came into this wonderful new era of cell and gene therapies.

我們甚至進入了細胞和基因 治療法的美好新時代。

But the biggest change to fix our hospital system altogether

但要完全修正醫院體制的重大改變

is still ahead of us.

還在前面等著我們。

And I believe it's time now, we have the opportunity,

我相信時候到了，我們有機會

to revolutionize the system altogether

可以將這個體制完全改革，

and forget about our current hospital system.

別管我們目前的醫院體制。

I believe it's time to create a new system

我相信，該是創造出一個

that revolves around health care at home.

以居家健康照護為中心的 新體制的時候了。

Recent research has shown

近期的研究指出，

that 46 percent of hospital care

46% 的醫院照護

can move to the patient's home.

可以移至病人家中。

That's a lot.

那是很大的量。

And that's mainly for those patients who suffer from chronic diseases.

主要都是提供給 慢性疾病病人的照護。

With that, hospitals can and should

若能這麼做，醫院可以／應該

reduce to smaller, agile and mobile care centers

減縮到較小、靈活， 且機動式的照護中心，

focused on acute care.

著重急性照護。

So things like neonatology, intensive care, surgery and imaging

所以，像是新生兒科學、

重病特別護理、手術和成像功能，

will still remain at the hospitals,

都繼續留在醫院中，

at least I believe for the foreseeable future.

至少，我相信在 可預見的未來能做到。

A few weeks ago, I met a colleague

幾週前，我和一位同事見面，

whose mom was diagnosed with incurable cancer,

她的母親被診斷出 無法治療的癌症，

and she said, "Niels, it's hard.

她說：「尼歐斯，這好難熬。

It's so hard when we know that she's got only months to live.

當我們知道她只能再活 一個月時，真的好難熬。

Instead of playing with the grandchildren,

現在她不能再和孫子孫女們玩，

she now has to travel three times a week

因為她一週要去阿姆斯特丹三次，

每次路程要花兩小時，

two hours up and down to Amsterdam

just to get her treatment and tests."

只為了接受治療和檢測。」

And that really breaks my heart,

那真的讓我心碎，

because we all know that a professional nurse

因為我們都知道，專業的護士

could draw her blood at home as well, right?

可以在家中幫她做抽血，對吧？

And if she could get her tests and treatment at home as well,

如果也能夠把檢測和治療移到家中，

she could do the things that are really important to her

在她人生中的最後一個月， 她就可以做對她而言

in her last months.

真正重要的事情。

My own mom, 82 years old now -- God bless her --

我自己的母親現在 82 歲了—— 願上帝保祐她——

she's avoiding to go to the hospital

她會避免去醫院，

because she finds it difficult to plan and manage the journey.

因為她覺得要規劃和管理 去醫院的行程很困難。

So my sisters and I, we help her out.

我和我的姐妹會幫她。

But there's many elderly people who are avoiding care

但有很多老年人都在避免去醫院，

and are waiting that long that it becomes life-threatening,

一直等到生命受到威脅的時候，

直接就去昂貴的重病特別護理。

and it's straight to the costly, intensive care.

Dr. Covinsky, a clinical researcher at the University of California,

加州大學的柯文斯基博士 是一位臨床研究者，

he concludes that a third of patients over 70

他斷定，超過 70 歲的病人 當中有三分之一，

and more than half of patients over 85,

85 歲以上的病人有至少二分之一，

leave the hospital more disabled than when they came in.

在離開醫院時， 比進入醫院時還要更糟。

And a very practical problem

許多病人在必須要去醫院的時候

that many patients face when they have to go to a hospital is:

會面臨到一個很實際的問題：

Where do I go with my main companion in life,

我如何安置我人生中的主要伴侶？

where do I go with my dog?

我如何安置我的狗？

That's our dog, by the way. Isn't she cute?

順道一提，這是 我們的狗，很可愛吧？

(Laughter)

（笑聲）

But it's not only about convenience.

但要想的不只是方便性。

It's also about unnecessary health care stays and costs.

還要考量健康照護的住院和成本， 那些不見得是必要的。

A friend of mine, Art,

我有一位朋友叫阿爾特，

he recently needed to be hospitalized for just a minor surgery,

因為一個小手術，他最近需要住院，

and he had to stay in the hospital for over two weeks,

他得要在醫院待超過兩週，

just because he needed a specific kind of IV antibiotics.

只因為他需要一種特定的 靜脈注射抗生素。

So he occupied a bed for two weeks

一張床就這樣被他佔了兩週，

that cost over a thousand euros a day.

成本是每日至少 1000 歐元。

It's just ridiculous.

這很荒唐。

And these costs are really at the heart of the issue.

這個議題的核心就是這些成本。

So we've seen over many of our global economies,

我們調查過很多全球經濟體，

health care expense grow as a percentage of GDP

在過去幾年， 健康照護花費的成長是以

GDP 的百分比來計算的。

over the last years.

So here we see that over the last 50 years,

這裡，我們可以看到， 在過去 50 年間，

health care expense has grown from about five percent in Germany

在德國，健康照護花費 從大約 5% 成長到

to about 11 percent now.

目前約為 11%。

In the US, we've seen growth from six percent to over 17 percent now.

在美國，我們看到的成長 是從 6% 變為現在的 17%。

And a large portion of these costs are driven by investments

這些成本當中有很大一部分 是由投資所造成，

in large, shiny hospital buildings.

投資建造大型、亮眼的醫院建築物。

And these buildings are not flexible,

這些建築物沒有彈性，

and they maintain a system where hospital beds need to be filled

它們持續使用的體制是 必須要讓每張病床都有病人，

for a hospital to run efficiently.

醫院的營運才會有效益。

There's no incentive for a hospital to run with less beds.

沒有任何獎勵在鼓勵 病床比較少的醫院。

Just the thought of that makes you sick, right?

光是想到這一點， 就讓人作噁，對吧？

And here's the thing: the cost for treating my buddy Art at home

重點來了：若我的朋友阿爾特 能在家中接受治療，

can be up to 10 times cheaper than hospital care.

成本會比醫院照護要便宜十倍。

And that is where we're headed.

這就是我們的目標。

The hospital bed of the future will be in our own homes.

未來，醫院的病床 會在我們自己家中。

And it's already starting.

這已經開始了。

Global home care is growing 10 percent year over year.

每年，全球的居家照護 都有 10% 的成長。

And from my own experience, I see that logistics and technology

依我自己的經驗， 我看到的是物流和科技

are making these home health care solutions work.

讓這些居家照護的 解決方案變成是可行的。

Technology is already allowing us to do things

科技已經讓我們能夠做到

that were once exclusive to hospitals.

一些曾經只有醫院才能做的事了。

Diagnosis tests like blood,

診斷檢測，像是驗血、

glucose tests, urine tests, can now be taken in the comfort of our homes.

驗葡萄糖、驗尿， 現在都能在家中舒適地進行。

And more and more connected devices

也有越來越多連結的裝置出現，

we see like pacemakers and insulin pumps

像是心律調節器和胰島素幫浦，

that will proactively signal if help is needed soon.

如果很快就會需要協助， 這些裝置會主動預先發出警訊。

And all that technology is coming together

把所有這些科技整合在一起，

in much more insights into the patients' health,

就能對病人的健康 狀況有更多洞見，

and that insight and all of the information leads to better control

那些洞見和所有這些資訊， 會帶來更佳的控制

and to less medical errors --

和更少的醫療疏失——

remember, the third cause of death

記得嗎，在美國排名第三的死因。

in the US.

And I see it every day at work.

每天，我工作時都會看到。

I work in logistics

我做的是物流，

and for me, home health care works.

對我來說，居家照護是行得通的。

So we see a delivery driver deliver the medicine

我們看到貨運司機

把藥物送到病人家中。

to the patient's home.

A nurse joins him and actually administers the drug

一位護士與他同行，

在病人的家中協助用藥。

at the patient's home.

It's that simple.

就那麼簡單。

Remember my buddy, Art?

還記得我的朋友阿爾特嗎？

He can now get the IV antibiotics in the comfort of his home:

他現在能舒適地在家中 接受靜脈注射抗生素：

no hospital pajamas, no crappy food

不用穿醫院的病人服， 不用吃很爛的食物，

and no risk of these antibiotic-resistant superbugs

也沒那些在醫院出沒、不怕抗生素，

that only bite you in these hospitals.

只會噬你的超級細菌。

And it goes further.

還不只如此。

So now the elderly people can get the treatment that they need

這樣老人就可以在自己舒適的家中

得到他們所需的治療，

in the comfort of their own home

while with their best companion in life.

身邊還有人生中最重要的伴侶陪著。

And there's no need anymore to drive hours and hours

不再需要只為了治療和檢測

就開數個小時的車跑一趟。

just to get your treatment and tests.

In the Netherlands and in Denmark,

在荷蘭和丹麥，

we've seen very good successes in cancer clinics

在癌症診所中， 我們看到很成功的例子，

organizing chemotherapies at the patient's homes,

將化療整合移入病人的家中，

sometimes even together with fellow patients.

有時甚至和幾位病人朋友一起。

The best improvements for these patients

對這些病人來說，最大的改善

have been improvements in reduction in stress,

就是這種方式減輕了他們的壓力、

anxiety disorders and depression.

焦慮症，以及憂鬱症。

Home health care also helped them to get back a sense of normality

居家健康照護也協助他們找回

生活中正常和自由的感覺，

and freedom in their lives,

and they've actually helped them to forget about their disease.

真的讓他們能夠忘掉自己生病了。

But home health care, Niels --

但，居家健康照護，尼歐斯——

what if I don't even have a home, when I'm homeless,

如果我連家都沒有呢？ 若我是無家可歸的人，怎麼辦？

or when I do have a home but there's no one to take care of me

或是我確實有家， 但在家中沒人照顧我，

or even open up the door?

甚至沒人幫我開門呢？

Well, in comes our sharing economy,

嗯，這時就要介紹我們的共享經濟，

or, as I like to call it, the Airbnb for home care.

或者，我喜歡稱它為居家照護的 Airbnb（短期出租民宿的平台）。

In the Netherlands, we see churches and care organizations

在荷蘭，可以看到 有些教堂和照護組織

match people in need of care and company

會協助配對有需要照護的人，

with people who actually have a home for them

以及有家可以供他們居住

and can provide care and company to them.

同時能提供照護和陪伴的人。

Home health care is cheaper,

居家健康照護很便宜，

it's easier to facilitate, and it's quick to set up --

它很容易促成，設置也很快速——

in these rural areas we talked about, but also in humanitarian crisis situations

在我們談到的這些郊區中， 以及在人道主義危機的情況下，

where it's often safer, quicker and cheaper to set things up at home.

把這些東西設置在家中通常會 較安全、較快速，也較便宜。

Home health care is very applicable in prosperous areas

居家健康照護很能夠 應用到繁榮的地區，

but also very much in underserved communities.

也同樣能用在服務不完備的社區。

Home health care works in developed countries

居家健康照護 在已開發國家中可行，

as well as in developing countries.

在開發中國家也一樣可行。

So I'm passionate to help facilitate improvements in patients' lives

所以，我很有熱忱地 想要促成居家健康照護，

以協助改善病人的生活。

due to home health care.

I'm passionate to help facilitate

我很有熱忱地協助促成

that the elderly people get the treatment that they need

老人在自己舒適的家中

in the comfort of their own homes,

取得他們所需要的治療，

together with their best companion in life.

身邊還有他們人生中 最重要的伴侶。

I'm passionate to make the change

我很有熱忱地想要做出改變，

and help ensure that patients, and not their disease,

協助確保病人能掌控 他們自己的人生，

are in control of their lives.

不要把掌控權交給疾病。

To me, that is health care delivered at home.

對我來說，那就是 健康照護送到家。

Thank you.

謝謝大家。

(Applause)

（掌聲）