I'm waking up in a Boston hotel room

時間是早上四點。

and can only think of one thing:

我在波士頓一間飯店的房間中醒來，

tooth pain.

腦中只能想著一件事：

One of my ceramic inlays fell off the evening before.

牙痛。

Five hours later, I'm sitting in a dentist's chair.

前晚，我的其中一個瓷鑲體脫落了。

But instead of having a repair of my inlay so that I can get rid of my pain,

五小時之後，我坐在牙科的椅子上。

the dentist pitches me on the advantages of a titanium implant surgery.

但牙醫師並沒有修復我的瓷鑲體 好讓我脫離牙痛之苦，

Ever heard of that?

反而在跟我推銷鈦植牙手術的優點。

(Laughter)

有聽過嗎？

It essentially means to replace a damaged tooth

（笑聲）

by an artificial one,

基本上，就是要把一顆受損的牙齒

that is screwed into your jaw.

換成一顆人工牙齒，

Estimated costs for the implant surgery may add up to 10,000 US dollars.

用螺釘固定在你的下頜上。

Replacing the ceramic inlay I had before

植牙手術的估計成本 可能會高達一萬美金。

would come in at 100 US dollars.

把我之前的瓷鑲體換掉，

Was it my health or the money that could be earned with me

只要大約一百美元。

that was the biggest concern for my dentist?

到底是我的健康， 還是能從我身上賺到的錢，

As it turned out, my experience wasn't an isolated case.

是我的牙醫最先考量的事？

A study by a US national newspaper estimated that in the United States,

結果發現，我的經歷並非單一個案。

up to 30 percent of all surgical procedures --

美國一間報社的研究指出

including stent and pacemaker implantations,

在美國所有的手術當中 估計有三成──

hip replacements and uterus removals --

包括支架和心律調節器植入、

were conducted

髖關節置換，及子宮移除──

although other nonsurgical treatment options had not been fully exploited

被執行，

by the physician in charge.

儘管其他非手術的治療方式

Isn't that figure shocking?

尚未完全被其主治醫生利用過。

Numbers may be slightly different in other countries,

那數字不是挺嚇人的嗎？

but what it means is that if you go to a doctor in the US,

在其他國家，數字可能稍有不同，

you have a not-insignificant chance to be subjected to a surgical intervention

但這意味著，如果你在美國看醫生，

without there being an immediate need for it.

你有顯著的可能性， 會在不立即需要手術的情況下

Why is this?

就去接受手術治療。

Why are some practitioners incentivized to run such unnecessary procedures?

為什麼會這樣？

Well, perhaps it is because health care systems themselves

為什麼有些開業醫生會被獎勵 去做這類不必要的手術？

incentivize in a nonideal way

也許是因為健康照護體制本身，

towards applying or not applying certain procedures or treatments.

用一種不盡理想的方式，

As most health care systems reimburse practitioners

鼓勵採用／不採用某些手術或治療。

in a fee-for-service-based fashion

大部分的健康照護體制 對開業醫生的補助

on the number and kind of treatments performed,

是以一次一付的醫療費為基礎的，

it may be this economic incentive that tempts some practitioners

根據所進行之治療的 數量和類型來給付，

to rather perform high-profit surgical treatments

可能就是這種經濟獎勵 誘使一些開業醫生

instead of exploring other treatment options.

選擇採用高利潤的手術治療，

Although certain countries started to implement

而不去尋求其他治療選擇。

performance-based reimbursement,

雖然有些國家開始導入

anchored on a quality and efficacy matrix,

以績效為基礎的補助，

overall, there's very little in today's health care systems' architecture

根據的是品質和功效的矩陣，

to incentivize practitioners broadly

整體來說，現今的健康照護體制 結構中，很少會有這種方式，

to actively prevent the appearance of a disease in the first place

廣泛鼓勵開業醫生

and to limit the procedures applied to a patient

在一開始就主動去預防疾病出現，

to the most effective options.

並只對病人進行

So how do we fix this?

能達到最大效用的手術。

What it may take is a fundamental redesign

這問題要如何解決？

of our health care system's architecture --

可能會需要從根本上重新設計

a complete rethinking of the incentive structure.

我們的健康照護體制結構──

What we may need is a health care system

完全重新思考鼓勵結構。

that reimburses practitioners for keeping their customers healthy

我們需要把健康照護體制的報銷條件

instead of almost only paying for services once people are already sick.

改成是醫生要保持其客戶的健康，

What we may need is a transformation

而不是幾乎只支付 已病之後的治療服務。

from today's system that largely cares for the sick,

我們得要轉變，

to a system that cares for the healthy.

從現今主要在照護病人的體制，

To change our current "sick care" approach

轉變為照護健康的體制。

into a true "health care" approach.

把我們目前的「生病照護」方法，

It is a paradigm shift from treating people once they have become sick

改變為真正的「健康照護」方法。

to preserving the health of the healthy before they get sick.

這是一種典範轉移， 從在大家生病之後才進行治療，

This shift may move the focus of all those involved --

變成在他們生病之前 就維持他們的健康。

from doctors, to hospitals, to pharmaceutical and medical companies --

這種轉移，可能會讓所有 相關人士的焦點改變──

on the product that this industry ultimately sells:

醫生、醫院、藥廠， 及醫療器材公司──

health.

把重心改放到這個產業 最終要銷售的產品上：

Imagine the following.

健康。

What if we redesign our health care system

想像以下情況。

into one that does not reimburse practitioners

如果我們重新設計健康照護體制，

for the actual procedures performed on a patient

這個體制不會補助開業醫生

but rather reimburses doctors, hospitals,

對於病人實際上執行的手術，

pharmaceutical and medical companies

而是補助醫生、醫院、

for every day a single individual is kept healthy

藥廠，以及醫療器材公司，

and doesn't develop a disease?

每天每一個病人能保持健康無疾病，

In practical terms, we could, for example,

就能得到補助？

use public money to pay a health fee to an insurance company

就實際面來說，比如，我們可以

for every day a single individual is kept healthy

用公款來支付健康費給保險公司，

and doesn't develop a disease

只要每天每一個人能保持健康

or doesn't require any other form of acute medical intervention.

無疾病，

If the individual becomes sick,

或是不需要任何其他形式的 急性醫療干預就付款。

the insurance company will not receive any further monetary compensation

如果一個人生了病，

for the medical interventions required to treat the disease of that individual,

保險公司不會從治療這個人之疾病 所需要進行的醫療干預

but they would be obliged to pay for every evidence-based treatment option

收到任何進一步的金錢補助，

to return the customer back to health.

他們反而有義務要支付 讓客戶恢復健康的治療選擇，

Once the customer's healthy again,

只要有證據佐證治療的必要性。

the health fee for that individual will be paid again.

一旦客戶再次恢復健康，

In effect, all players in the system

他們就會再次收到那個人的健康費。

are now responsible for keeping their customers healthy,

實際上，在這個體制中的所有參與者

and they're incentivized to avoid any unnecessary medical interventions

現在都有責任要保持客戶健康，

by simply reducing the number of people that eventually become sick.

他們若能避免不必要的 醫療干預，就能得到獎勵，

The more healthy people there are,

只要做到減少生病的人數。

the less the cost to treat the sick will be,

大家越健康，

and the higher the economic benefit for all parties being involved

治療疾病的成本就會越低，

in keeping these individuals healthy is.

而保持每位客戶健康的相關各方，

This change of the incentive structure shifts, now,

也會有更高的經濟利益。

the attention of the complete health care system

將獎勵結構做這種改變，

away from providing isolated and singular treatment options,

會轉移整個健康照護體制的注意力，

towards a holistic view of what is useful

從專注在提供獨立 且單一的治療選擇，

for an individual to stay healthy and live long.

轉變成「全人視角」， 關注的是要做什麼

Now, to effectively preserve health,

才能讓人保持健康和長壽。

people will need to be willing to share their health data

若要有效地保持健康，

on a constant basis,

大家得要願意分享他們的健康資料，

so that the health care system understands early enough

且要經常分享，

if any assistance with regard to their health is needed.

這麼一來，健康照護體制 就能在夠早的時間點

Physical examination,

去了解大家的健康 需要什麼樣的協助。

monitoring of lifetime health data

健康檢查、

as well as genetic sequencing, cardiometabolic profiling

監控終身健康資料，

and imaging-based technologies

還有 DNA 定序、心血管代謝側寫，

will allow customers to make,

以及成像相關的技術，

together with health coaches and general practitioners,

會讓客戶配合健康教練

optimal and science-guided decisions --

和一般開業醫生

for their diet, their medication and their physical activity --

做出由科學所引導的最佳決策──

to diminish their unique probability

包括飲食、用藥，以及 身體活動相關的決策──

to fall sick of an identified, individual high-risk disease.

以降低每個人得到

Artificial intelligence-based data analysis

每種可辨視之高風險疾病的機率。

and the miniaturization of sensor technologies

以人工智慧為基礎的資料分析

are already starting to make monitoring of the individual health status possible.

以及感測器技術的微型化，

Measuring cardiometabolic parameters by devices like this

已經開始讓監控 個人健康狀況成為可能。

or the detection of circulating tumor DNA in your bloodstream

用像這樣的裝置來 測量心血管代謝參數，

early on after cancer disease onset

或及早在癌症襲擊之前 就先偵測你的血液中

are only two examples for such monitoring technologies.

有無血液循環腫瘤 DNA，

Take cancer.

只是這類監控技術的兩個例子而已。

One of the biggest problems in certain oncological diseases

比如癌症。

is that a large number of patients is diagnosed too late

某些腫瘤疾病遇到最大的問題之一，

to allow them to be cured,

就是太多病人都太晚才被診斷出來，

although the drugs and treatments that could potentially have cured them

已經來不及治癒，

are already existing today,

儘管現今已經有些藥品和治療

if the disease had only been detected earlier.

有可能治癒他們，

New technologies allow now, based on a few milliliters of blood,

只要疾病能更早被偵測出來。

to detect the presence of circulating tumor DNA

現在的新技術已經 能根據幾毫升的血液

and thus, the presence of cancer,

偵測出是否有血液循環腫瘤 DNA，

early on in a really convenient manner.

因此，在早期就能用

The impact that this early-stage detection can have

很方便的方式偵測出癌症。

may be dramatic.

這種早期偵測會造成的影響

The five-year survival rate for non-small cell lung cancer

是非常巨大的。

when diagnosed at stage one, which is early, is 49 percent.

非小細胞肺癌的五年存活率，

The same, when diagnosed at stage four, which is late,

如果在第一期，也就是很早期 就診斷出來，五年存活率是 49%。

is below one percent.

如果在第四期， 也就是很晚期才診斷出來，

Being potentially able to prevent a large number of deaths

五年存活率是就不到 1%。

by something as simple as a blood test for circulating tumor DNA

只要用很簡單的東西，像是 血液循環腫瘤 DNA 的血液檢測，

could make certain cancer types a manageable disease,

就有可能預防許多人喪命，

as disease onset can be detected earlier

它能讓某些類型的癌症 變成可以控管的疾病，

and positive treatment outcomes can likely be increased.

疾病的攻擊能及早被偵測出來，

In 2012,

因此也更可能會有正面的治療結果。

50 percent of all Americans had a single chronic disease,

2012 年，

resulting in 86 percent of the $3 trillion US health care budget

有 50% 的美國人 得了單一種慢性病，

being spent for treating such chronic diseases.

導致美國的三兆美元 健康照護預算有 86%

Eighty-six percent.

花在治療這類慢性病上。

If new technologies allow now to reduce this 86 percent,

86%。

why have health care systems not reacted and changed already?

如果新技術能減低這 86%，

Well, a redesign of what today is a sick care system

為什麼健康照護體制 還沒有反應和改變？

into a true health care system that focuses on prevention

要把現今的生病照護體制

and behavioral changes

重新設計成真正的健康照護體制，

requires every actor in the system to change.

需要把焦點放在預防和行為改變上，

It requires the political willingness to shift budgets and policies

這需要體制中的 每個行為者都做出改變。

towards prevention and health education

這也需要政治意願，

to design a new set of financial and non-financial incentives.

將預算和政策轉向預防和健康教育，

It requires creating a regulatory framework

來設計一組新的財務 和非財務獎勵方式。

for the gathering, using and sharing of personal health data

這就需要創造一個規範的架構，

that's at the same time stringent and sensible.

來收集、使用和分享個人健康資料，

It needs doctors, hospitals, insurers, pharmaceutical and medical companies

既嚴格且合理的規範架構。

to reframe their approach and, most important,

這需要醫生、醫院、保險業者、 藥廠，以及醫療器材公司

it can't happen without the willingness and motivation

重新調整他們的方法， 然後，最重要的是，

of individuals to change their lifestyle in a sustained way,

這件事若要成真，得仰賴每個人都有

to prioritize staying healthy,

意願和動機去改變他們的 生活方式，變得更永續，

in addition to opening up for sharing the health data on a constant basis.

把保持健康列為優先事項，

This change may not come overnight.

此外還要能開放地 經常分享健康資料。

But by refocusing the incentives within the health care industry today

這種改變不會一夕成真。

to actively keep people healthy,

但現在就在健康照護產業中 將獎勵的焦點改變為

we may not only be able to prevent more diseases in the first place

主動保持民眾健康，

but we may also be able to detect the onset of certain preventable diseases

我們不只能在一開始 就先預防更多的疾病，

earlier than we do today,

我們也能夠偵測出某些 可預防之疾病的發生，

which will lead to longer and healthier lives for more people.

且比現今能做到的更早，

Most of the technologies that we need to initiate that change

這就會讓更多人能更長壽、更健康。

are already existing today.

要開始這項改變，我們所需要的技術

But this is not a technology question.

大多已經存在了。

It is primarily a question of vision

這不是個技術問題。

and will.

根本上，這是個遠見

Thanks a lot.

以及意願的問題。

(Applause)

非常謝謝。