but I don't like to be in a hospital

各位可能不會覺得意外，

or go to a hospital.

我並不喜歡待在醫院裡，

Do you?

也不喜歡去醫院。

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

你們呢？

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

我相信許多人都有同感，對吧？

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

但，為什麼？我們 為什麼這麼討厭醫院？

Is it the crappy food?

還是這就只是個人生的 事實，我們得要接受？

Is it the expensive parking?

問題在於醫院食物很爛嗎？

Is it the intense smell?

還是停車費太貴？

Or is it the fear of the unknown?

還是那種很強烈的氣味？

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

或是對於未知的恐懼？

Patients often have to travel long distances

嗯，以上全部都是，且還有別的。

to get to their nearest hospital,

病人通常都需要跑很遠的一段路

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

才能到最近的醫院，

in rural areas,

而取得醫院照護 漸漸變成了一個議題，

in the US,

在郊區是如此，

but also in sparsely populated countries like Sweden.

在美國是如此，

And even when hospitals are more abundant,

在人口很分散的國家 如瑞典亦是如此。

typically the poor and the elderly

即使是在醫院很充足的情況下，

have trouble getting care because they lack transportation

通常，窮人和老人

that is convenient and affordable to them.

也不容易取得照護，因為他們缺乏

And many people are avoiding hospital care altogether,

方便且能夠負擔得起的交通工具。

and they miss getting proper treatment

許多人就甘脆直接避免醫院照護了，

due to cost.

他們錯過了取得適當治療的機會，

We see that 64 percent of Americans

只因為成本考量。

are avoiding care due to cost.

有 64% 的美國人

And even when you do get treatment,

因為成本因素而避開照護。

hospitals often make us sicker.

即使當你真的接受治療時，

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

醫院通常也會讓我們病得更重。

just behind cancer and heart disease,

根據報告，在美國 排名第三的死因是醫療疏失，

the third cause of death.

只輸給癌症和心臟疾病。

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

排名第三的死因。

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

我已經做健康照護二十多年了，

Let me give you two examples.

每天，我都會目擊我們的 醫院體制有多糟糕、多過時。

Four in 10 Japanese medical doctors

讓我舉兩個例子來說明。

and five in 10 American medical doctors

十個日本醫生當中有四個，

are burnt out.

十個美國醫生當中有五個，

In my home country, the Netherlands,

都累到筋疲力竭。

only 17 million people live there.

在我的祖國，荷蘭，

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

居民只有 1700 萬人。

But how did we even end up here,

在接下來的幾年， 我們會缺 12 萬 5 千名護士。

in this idea of placing all kinds of sick people

但我們是怎麼落到這個地步的？

together in one big building?

把各種生病的人 全都送到一棟大樓裡，

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

這個想法是哪來的？

In 400 BC, temples for cure were erected

這就得追溯回古希臘時代了。

where people could go to get their diagnosis,

西元前 400 年，建立了治療所，

their treatment and their healing.

人們可以去治療所取得診斷、

And then really for about 2,000 years,

接受治療，並被治癒。

we've seen religious care centers

接下來的大約 2000 年，

all the way up to the Industrial Revolution,

我們看到了宗教照護中心，

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

一直到工業革命，

based on the principles of the Industrial Revolution,

那時是用裝配線的方式設立醫院，

to produce efficiently

依據的就是工業革命的原則，

and get the products, the patients in this case,

以增加生產效能，

out of the hospital as soon as possible.

並讓產品——用在醫院時， 產品就是指病人——

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

盡快從醫院出來。

We figured out how to make insulin.

在過去一個世紀， 我們看到了許多有趣的創新。

We invented pacemakers and X-ray,

我們找到方法來製造胰島素。

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

我們發明了心律調節器和 X 光，

But the biggest change to fix our hospital system altogether

我們甚至進入了細胞和基因 治療法的美好新時代。

is still ahead of us.

但要完全修正醫院體制的重大改變

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

還在前面等著我們。

to revolutionize the system altogether

我相信時候到了，我們有機會

and forget about our current hospital system.

可以將這個體制完全改革，

I believe it's time to create a new system

別管我們目前的醫院體制。

that revolves around health care at home.

我相信，該是創造出一個

Recent research has shown

以居家健康照護為中心的 新體制的時候了。

that 46 percent of hospital care

近期的研究指出，

can move to the patient's home.

46% 的醫院照護

That's a lot.

可以移至病人家中。

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

那是很大的量。

With that, hospitals can and should

主要都是提供給 慢性疾病病人的照護。

reduce to smaller, agile and mobile care centers

若能這麼做，醫院可以／應該

focused on acute care.

減縮到較小、靈活， 且機動式的照護中心，

So things like neonatology, intensive care, surgery and imaging

著重急性照護。

will still remain at the hospitals,

所以，像是新生兒科學、

at least I believe for the foreseeable future.

重病特別護理、手術和成像功能，

A few weeks ago, I met a colleague

都繼續留在醫院中，

whose mom was diagnosed with incurable cancer,

至少，我相信在 可預見的未來能做到。

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

幾週前，我和一位同事見面，

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

她的母親被診斷出 無法治療的癌症，

Instead of playing with the grandchildren,

她說：「尼歐斯，這好難熬。

she now has to travel three times a week

當我們知道她只能再活 一個月時，真的好難熬。

two hours up and down to Amsterdam

現在她不能再和孫子孫女們玩，

just to get her treatment and tests."

因為她一週要去阿姆斯特丹三次，

And that really breaks my heart,

每次路程要花兩小時，

because we all know that a professional nurse

只為了接受治療和檢測。」

could draw her blood at home as well, right?

那真的讓我心碎，

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

因為我們都知道，專業的護士

she could do the things that are really important to her

可以在家中幫她做抽血，對吧？

in her last months.

如果也能夠把檢測和治療移到家中，

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

在她人生中的最後一個月， 她就可以做對她而言

she's avoiding to go to the hospital

真正重要的事情。

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

我自己的母親現在 82 歲了—— 願上帝保祐她——

So my sisters and I, we help her out.

她會避免去醫院，

But there's many elderly people who are avoiding care

因為她覺得要規劃和管理 去醫院的行程很困難。

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

我和我的姐妹會幫她。

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

但有很多老年人都在避免去醫院，

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

一直等到生命受到威脅的時候，

he concludes that a third of patients over 70

直接就去昂貴的重病特別護理。

and more than half of patients over 85,

加州大學的柯文斯基博士 是一位臨床研究者，

leave the hospital more disabled than when they came in.

他斷定，超過 70 歲的病人 當中有三分之一，

And a very practical problem

85 歲以上的病人有至少二分之一，

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

在離開醫院時， 比進入醫院時還要更糟。

Where do I go with my main companion in life,

許多病人在必須要去醫院的時候

where do I go with my dog?

會面臨到一個很實際的問題：

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

我如何安置我人生中的主要伴侶？

(Laughter)

我如何安置我的狗？

But it's not only about convenience.

順道一提，這是 我們的狗，很可愛吧？

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

（笑聲）

A friend of mine, Art,

但要想的不只是方便性。

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

還要考量健康照護的住院和成本， 那些不見得是必要的。

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

我有一位朋友叫阿爾特，

just because he needed a specific kind of IV antibiotics.

因為一個小手術，他最近需要住院，

So he occupied a bed for two weeks

他得要在醫院待超過兩週，

that cost over a thousand euros a day.

只因為他需要一種特定的 靜脈注射抗生素。

It's just ridiculous.

一張床就這樣被他佔了兩週，

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

成本是每日至少 1000 歐元。

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

這很荒唐。

health care expense grow as a percentage of GDP

這個議題的核心就是這些成本。

over the last years.

我們調查過很多全球經濟體，

So here we see that over the last 50 years,

在過去幾年， 健康照護花費的成長是以

health care expense has grown from about five percent in Germany

GDP 的百分比來計算的。

to about 11 percent now.

這裡，我們可以看到， 在過去 50 年間，

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

在德國，健康照護花費 從大約 5% 成長到

And a large portion of these costs are driven by investments

目前約為 11%。

in large, shiny hospital buildings.

在美國，我們看到的成長 是從 6% 變為現在的 17%。

And these buildings are not flexible,

這些成本當中有很大一部分 是由投資所造成，

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

投資建造大型、亮眼的醫院建築物。

for a hospital to run efficiently.

這些建築物沒有彈性，

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

它們持續使用的體制是 必須要讓每張病床都有病人，

Just the thought of that makes you sick, right?

醫院的營運才會有效益。

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

沒有任何獎勵在鼓勵 病床比較少的醫院。

can be up to 10 times cheaper than hospital care.

光是想到這一點， 就讓人作噁，對吧？

And that is where we're headed.

重點來了：若我的朋友阿爾特 能在家中接受治療，

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

成本會比醫院照護要便宜十倍。

And it's already starting.

這就是我們的目標。

Global home care is growing 10 percent year over year.

未來，醫院的病床 會在我們自己家中。

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

這已經開始了。

are making these home health care solutions work.

每年，全球的居家照護 都有 10% 的成長。

Technology is already allowing us to do things

依我自己的經驗， 我看到的是物流和科技

that were once exclusive to hospitals.

讓這些居家照護的 解決方案變成是可行的。

Diagnosis tests like blood,

科技已經讓我們能夠做到

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

一些曾經只有醫院才能做的事了。

And more and more connected devices

診斷檢測，像是驗血、

we see like pacemakers and insulin pumps

驗葡萄糖、驗尿， 現在都能在家中舒適地進行。

that will proactively signal if help is needed soon.

也有越來越多連結的裝置出現，

And all that technology is coming together

像是心律調節器和胰島素幫浦，

in much more insights into the patients' health,

如果很快就會需要協助， 這些裝置會主動預先發出警訊。

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

把所有這些科技整合在一起，

and to less medical errors --

就能對病人的健康 狀況有更多洞見，

remember, the third cause of death

那些洞見和所有這些資訊， 會帶來更佳的控制

in the US.

和更少的醫療疏失——

And I see it every day at work.

記得嗎，在美國排名第三的死因。

I work in logistics

每天，我工作時都會看到。

and for me, home health care works.

我做的是物流，

So we see a delivery driver deliver the medicine

對我來說，居家照護是行得通的。

to the patient's home.

我們看到貨運司機

A nurse joins him and actually administers the drug

把藥物送到病人家中。

at the patient's home.

一位護士與他同行，

It's that simple.

在病人的家中協助用藥。

Remember my buddy, Art?

就那麼簡單。

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

還記得我的朋友阿爾特嗎？

no hospital pajamas, no crappy food

他現在能舒適地在家中 接受靜脈注射抗生素：

and no risk of these antibiotic-resistant superbugs

不用穿醫院的病人服， 不用吃很爛的食物，

that only bite you in these hospitals.

也沒那些在醫院出沒、不怕抗生素，

And it goes further.

只會噬你的超級細菌。

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

還不只如此。

in the comfort of their own home

這樣老人就可以在自己舒適的家中

while with their best companion in life.

得到他們所需的治療，

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

身邊還有人生中最重要的伴侶陪著。

just to get your treatment and tests.

不再需要只為了治療和檢測

In the Netherlands and in Denmark,

就開數個小時的車跑一趟。

we've seen very good successes in cancer clinics

在荷蘭和丹麥，

organizing chemotherapies at the patient's homes,

在癌症診所中， 我們看到很成功的例子，

sometimes even together with fellow patients.

將化療整合移入病人的家中，

The best improvements for these patients

有時甚至和幾位病人朋友一起。

have been improvements in reduction in stress,

對這些病人來說，最大的改善

anxiety disorders and depression.

就是這種方式減輕了他們的壓力、

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

焦慮症，以及憂鬱症。

and freedom in their lives,

居家健康照護也協助他們找回

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

生活中正常和自由的感覺，

But home health care, Niels --

真的讓他們能夠忘掉自己生病了。

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

但，居家健康照護，尼歐斯——

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

如果我連家都沒有呢？ 若我是無家可歸的人，怎麼辦？

or even open up the door?

或是我確實有家， 但在家中沒人照顧我，

Well, in comes our sharing economy,

甚至沒人幫我開門呢？

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

嗯，這時就要介紹我們的共享經濟，

In the Netherlands, we see churches and care organizations

或者，我喜歡稱它為居家照護的 Airbnb（短期出租民宿的平台）。

match people in need of care and company

在荷蘭，可以看到 有些教堂和照護組織

with people who actually have a home for them

會協助配對有需要照護的人，

and can provide care and company to them.

以及有家可以供他們居住

Home health care is cheaper,

同時能提供照護和陪伴的人。

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

居家健康照護很便宜，

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

它很容易促成，設置也很快速——

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

在我們談到的這些郊區中， 以及在人道主義危機的情況下，

Home health care is very applicable in prosperous areas

把這些東西設置在家中通常會 較安全、較快速，也較便宜。

but also very much in underserved communities.

居家健康照護很能夠 應用到繁榮的地區，

Home health care works in developed countries

也同樣能用在服務不完備的社區。

as well as in developing countries.

居家健康照護 在已開發國家中可行，

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

在開發中國家也一樣可行。

due to home health care.

所以，我很有熱忱地 想要促成居家健康照護，

I'm passionate to help facilitate

以協助改善病人的生活。

that the elderly people get the treatment that they need

我很有熱忱地協助促成

in the comfort of their own homes,

老人在自己舒適的家中

together with their best companion in life.

取得他們所需要的治療，

I'm passionate to make the change

身邊還有他們人生中 最重要的伴侶。

and help ensure that patients, and not their disease,

我很有熱忱地想要做出改變，

are in control of their lives.

協助確保病人能掌控 他們自己的人生，

To me, that is health care delivered at home.

不要把掌控權交給疾病。

Thank you.

對我來說，那就是 健康照護送到家。

(Applause)

謝謝大家。