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仅做 整合 / 美化 处理
Probably not a surprise to you,
也许你不会惊讶，
but I don't like to be in a hospital
我不喜欢呆在医院，
or go to a hospital.
或去医院看病。
Do you?
你喜欢吗？
I'm sure many of you feel the same way, right?
我相信你们很多人 有同样的感受，对吗？
But why? Why is it that we hate hospitals so much?
但为什么？为什么我们如此厌恶医院？
Or is it just a fact of life we have to live with?
这不是生活中不可避免的一个事实吗？
Is it the crappy food?
是难吃的病号饭？
Is it the expensive parking?
是昂贵的停车费？
Is it the intense smell?
是强烈的药水气味？
Or is it the fear of the unknown?
或者是对未知的恐惧？
Well, it's all of that, and it's more.
全部都有，而且不止这些。
Patients often have to travel long distances
病人常常需要赶很长一段路
to get to their nearest hospital,
才能到最近的医院，
and access to hospital care is becoming more and more an issue
而且在美国的乡村地区
in rural areas,
要获得医院护理
in the US,
越来越成问题，
but also in sparsely populated countries like Sweden.
在瑞典这样人口稀少的国家也是如此。
And even when hospitals are more abundant,
即便当医院资源更加充裕时，
typically the poor and the elderly
特别是穷人和老人也通常
have trouble getting care because they lack transportation
因为缺乏便利，廉价的交通
that is convenient and affordable to them.
而无法获得医疗服务。
And many people are avoiding hospital care altogether,
许多人甚至完全避开医疗治疗，
and they miss getting proper treatment
为了节省开销而错过了
due to cost.
合适的治疗。
We see that 64 percent of Americans
我们可以看到，有64%的美国人
are avoiding care due to cost.
因为费用问题而避免医疗服务。
And even when you do get treatment,
即便你接受了治疗，
hospitals often make us sicker.
医院也常常会让我们病情加重。
Medical errors are reported to be the third cause of death in the US,
据报道，医疗事故是 美国的第三大致死因素，
just behind cancer and heart disease,
仅次于癌症和心脏疾病，
the third cause of death.
第三大死因。
I'm in health care for over 20 years now,
我从事医疗行业已经20多年了，
and I witness every day how broken and how obsolete our hospital system is.
每天我都见证着我们的医院系统 是如此的破败和落后。
Let me give you two examples.
让我给你们两个例子。
Four in 10 Japanese medical doctors
10个日本医生中有4个，
and five in 10 American medical doctors
10个美国医生中有5个
are burnt out.
已经在超负荷工作了。
In my home country, the Netherlands,
在我的祖国，荷兰，
only 17 million people live there.
只有1700万人口。
We are short 125,000 nurses over the coming years.
在未来几年，我们会缺少12.5万名护士。
But how did we even end up here,
但我们是怎么走到这一步的，
in this idea of placing all kinds of sick people
把所有病人都集中到
together in one big building?
一幢大楼里的？
Well, we have to go back to the Ancient Greeks.
这就要追溯到古希腊时期。
In 400 BC, temples for cure were erected
公元前400年，人们建造了治病的庙宇，
where people could go to get their diagnosis,
病人在那里可以得到诊断，
their treatment and their healing.
治疗和恢复。
And then really for about 2,000 years,
在之后的2000年间，
we've seen religious care centers
我们看到了教会的护理中心，
all the way up to the Industrial Revolution,
直到进入工业革命时期，
where we've seen hospitals being set up as assembly lines
我们看到医院基于工业革命的原则，
based on the principles of the Industrial Revolution,
像流水线那样尽快产出产品，
to produce efficiently
提升了生产效率，
and get the products, the patients in this case,
在医院的案例中，产品变成了病人，
out of the hospital as soon as possible.
以让他们尽快走出医院。
Over the last century, we've seen lots of interesting innovations.
在过去一个世纪中， 我们看到了很多有趣的创新。
We figured out how to make insulin.
我们找到了制造胰岛素的方法。
We invented pacemakers and X-ray,
我们发明了起搏器和X光，
and we even came into this wonderful new era of cell and gene therapies.
我们甚至进入了细胞和 基因治疗的奇妙新时代。
But the biggest change to fix our hospital system altogether
但修复我们医疗系统的最大变革
is still ahead of us.
仍然没有到来。
And I believe it's time now, we have the opportunity,
我相信现在是时候了，我们有机会
to revolutionize the system altogether
去彻底改革整个系统，
and forget about our current hospital system.
完全忘掉我们现有的医院系统。
I believe it's time to create a new system
我相信是时候创造新的，
that revolves around health care at home.
以家庭护理为中心的系统了。
Recent research has shown
最近的研究发现，
that 46 percent of hospital care
46%的医院治疗
can move to the patient's home.
可以转移到患者家中进行。
That's a lot.
这个数量相当庞大。
And that's mainly for those patients who suffer from chronic diseases.
这主要是针对那些患有慢性疾病的病人。
With that, hospitals can and should
对此，医院可以，而且应该
reduce to smaller, agile and mobile care centers
精简到专注于急症治疗的 更加小型，灵活和移动的
focused on acute care.
医疗中心。
So things like neonatology, intensive care, surgery and imaging
比如新生儿，重症监护，手术和成像，
will still remain at the hospitals,
这些可以仍然保留在医院，
at least I believe for the foreseeable future.
至少在可预见的未来是这样。
A few weeks ago, I met a colleague
几周前，我遇到一个同事,
whose mom was diagnosed with incurable cancer,
她妈妈被诊断患了癌症，时日无多。
and she said, "Niels, it's hard.
她说：“尼尔斯，真的很艰难。
It's so hard when we know that she's got only months to live.
当知道她只有几个月生命时， 一切都变得如此艰难。
Instead of playing with the grandchildren,
她无法再和孙子们玩耍了，
she now has to travel three times a week
现在她每周需要外出三次，
two hours up and down to Amsterdam
经历两个小时的颠簸到阿姆斯特丹，
just to get her treatment and tests."
就为了进行治疗和检查。”
And that really breaks my heart,
这让我感到很伤心，
because we all know that a professional nurse
因为我们都知道，一个专业的护士
could draw her blood at home as well, right?
在家就可以进行抽血操作，对吧？
And if she could get her tests and treatment at home as well,
如果她也能在家接受治疗和检查，
she could do the things that are really important to her
就可以利用她生命的 最后几个月做一些
in her last months.
真正对她重要的事情。
My own mom, 82 years old now -- God bless her --
我的母亲，现在82岁了 ——老天保佑她——
she's avoiding to go to the hospital
她不想去医院，
because she finds it difficult to plan and manage the journey.
因为她发现很难规划和管理她的行程。
So my sisters and I, we help her out.
于是我和妹妹会帮她搞定。
But there's many elderly people who are avoiding care
但有很多不去医院的老年人，
and are waiting that long that it becomes life-threatening,
拖的时间过长，到了危及生命的程度，
and it's straight to the costly, intensive care.
不得不直接进入昂贵的重症监护环节。
Dr. Covinsky, a clinical researcher at the University of California,
科文斯基博士，加州大学的临床研究员
he concludes that a third of patients over 70
得出结论，1/3年龄超过70岁的人
and more than half of patients over 85,
和超过一半年龄超过85岁的人，
leave the hospital more disabled than when they came in.
离开医院时比他们进来的时候更糟糕。
And a very practical problem
很多病人去医院
that many patients face when they have to go to a hospital is:
不得不面临的一个实际问题是：
Where do I go with my main companion in life,
我和我的主要生活伴侣要去哪里，
where do I go with my dog?
我和我的狗要去哪里？
That's our dog, by the way. Isn't she cute?
这是我的狗，她是不是很可爱？
(Laughter)
（笑声）
But it's not only about convenience.
但这并不只跟便利有关。
It's also about unnecessary health care stays and costs.
它还涉及到不必要的医疗住宿和费用。
A friend of mine, Art,
我的一个朋友，阿特，
he recently needed to be hospitalized for just a minor surgery,
他最近需要住院接受一个小手术，
and he had to stay in the hospital for over two weeks,
他不得不在医院呆两个星期，
just because he needed a specific kind of IV antibiotics.
只是因为他需要 一种特殊的静脉抗生素。
So he occupied a bed for two weeks
于是他占用了一张病床两周，
that cost over a thousand euros a day.
每天需要花费超过1千欧。
It's just ridiculous.
这真是荒谬。
And these costs are really at the heart of the issue.
这些费用正是问题的核心。
So we've seen over many of our global economies,
我们看到了很多全球经济中，
health care expense grow as a percentage of GDP
医疗支出在GDP中的 占比在过去这些年
over the last years.
一直在增长。
So here we see that over the last 50 years,
在过去50年间，
health care expense has grown from about five percent in Germany
医疗费用占比在德国从5%
to about 11 percent now.
上升到现在的11%。
In the US, we've seen growth from six percent to over 17 percent now.
在美国，这个比例从6%上升到17%。
And a large portion of these costs are driven by investments
这些花费中很大部分来于
in large, shiny hospital buildings.
对宏伟，熠熠生辉的医院建筑的投资。
And these buildings are not flexible,
这些大楼并不灵活，
and they maintain a system where hospital beds need to be filled
还维持着一个需要 让医院的床位被占满，
for a hospital to run efficiently.
以保持医院效率的体系。
There's no incentive for a hospital to run with less beds.
于是医院就没有动力减少床位。
Just the thought of that makes you sick, right?
一想到这个你就恶心，是吧？
And here's the thing: the cost for treating my buddy Art at home
事实上：我的朋友阿特在家治疗的费用
can be up to 10 times cheaper than hospital care.
要比医在院的花费便宜10倍。
And that is where we're headed.
那就是我们前进的方向。
The hospital bed of the future will be in our own homes.
医院未来的床位在我们自己的家中。
And it's already starting.
而且这种趋势已经开始了。
Global home care is growing 10 percent year over year.
全球家庭护理正在以 每年10%的速度增长。
And from my own experience, I see that logistics and technology
从我个人的经验来看，物流和技术
are making these home health care solutions work.
让家庭医疗护理变得可行。
Technology is already allowing us to do things
技术让我们可以做过去
that were once exclusive to hospitals.
只有医院才能做的事情。
Diagnosis tests like blood,
如血液，
glucose tests, urine tests, can now be taken in the comfort of our homes.
葡萄糖和尿液检测那样的诊断测试， 现在可以在舒适的家中进行。
And more and more connected devices
越来越多的联网设备，
we see like pacemakers and insulin pumps
如心脏起搏器和胰岛素泵，
that will proactively signal if help is needed soon.
在紧急情况下会发出预警信号。
And all that technology is coming together
所有这些技术组合在一起
in much more insights into the patients' health,
可以更加深入地理解病人的健康，
and that insight and all of the information leads to better control
这样的剖析和所有这些信息 可以带来更好的控制，
and to less medical errors --
并减少医疗事故——
remember, the third cause of death
记住，这可是美国第三大
in the US.
死因。
And I see it every day at work.
我每天都在工作中见证这些。
I work in logistics
我工作在物流领域，
and for me, home health care works.
对我而言，家庭医护的确可行。
So we see a delivery driver deliver the medicine
我们看到送货司机运输药物
to the patient's home.
到患者家中。
A nurse joins him and actually administers the drug
护士与他一道，在患者家中
at the patient's home.
进行管理药物。
It's that simple.
就是这么简单。
Remember my buddy, Art?
还记得我的朋友，阿特？
He can now get the IV antibiotics in the comfort of his home:
他现在可以在舒适的家中 获得静脉注射抗生素：
no hospital pajamas, no crappy food
不需要穿病号服，吃难吃的病号餐，
and no risk of these antibiotic-resistant superbugs
也不会面临被只存在于 医院中的那些耐抗生素的
that only bite you in these hospitals.
超级病菌叮咬的风险。
And it goes further.
好处还不止于此。
So now the elderly people can get the treatment that they need
现在老年人也可以在他们舒适的家中
in the comfort of their own home
获得所需要的治疗，
while with their best companion in life.
同时有生活中最佳伴侣陪同。
And there's no need anymore to drive hours and hours
也不再需要开车几个小时，
just to get your treatment and tests.
只是为了获得医疗和检查。
In the Netherlands and in Denmark,
在荷兰和丹麦，
we've seen very good successes in cancer clinics
我们在癌症诊所看到了
organizing chemotherapies at the patient's homes,
在病人家中组织化疗的非常成功的例子，
sometimes even together with fellow patients.
有时候甚至几个病友一起。
The best improvements for these patients
对于这些病人而言，
have been improvements in reduction in stress,
最大的改善在于压力、
anxiety disorders and depression.
焦虑障碍和抑郁的减轻。
Home health care also helped them to get back a sense of normality
家庭医护也帮助他们找回了生活中的
and freedom in their lives,
正常和自由的感觉，
and they've actually helped them to forget about their disease.
这其实也帮助他们忘记了病痛。
But home health care, Niels --
但关于家庭医护，尼尔斯——
what if I don't even have a home, when I'm homeless,
如果我没有家，当我无家可归时，
or when I do have a home but there's no one to take care of me
或者当我有家，但没人可以照看我，
or even open up the door?
或者连开窗户都没人帮忙时怎么办？
Well, in comes our sharing economy,
这个时候我们的共享经济就发挥作用了。
or, as I like to call it, the Airbnb for home care.
或者，我喜欢称之为，家庭医护爱彼迎。
In the Netherlands, we see churches and care organizations
在荷兰，我们看到教堂和护理机构
match people in need of care and company
会将需要护理和陪伴的人们，
with people who actually have a home for them
与有家并能提供医护
and can provide care and company to them.
和陪伴的人们进行匹配。
Home health care is cheaper,
家庭医护更便宜，
it's easier to facilitate, and it's quick to set up --
它易于安置，可以快速投入使用——
in these rural areas we talked about, but also in humanitarian crisis situations
在这些我们谈到的农村地区， 也在人道主义危机的情况下，
where it's often safer, quicker and cheaper to set things up at home.
把医疗设施放在家里通常 要更加安全，快速和廉价。
Home health care is very applicable in prosperous areas
家庭医护非常适用于繁荣地区，
but also very much in underserved communities.
但在服务水平低下的社区也是如此。
Home health care works in developed countries
家庭护理对发达国家有效，
as well as in developing countries.
对发展中国家也是如此。
So I'm passionate to help facilitate improvements in patients' lives
因此，我非常热衷于通过家庭医护服务
due to home health care.
帮助改善病人的生活。
I'm passionate to help facilitate
我热衷于帮助
that the elderly people get the treatment that they need
那些老年人在自己舒适的家中
in the comfort of their own homes,
获得所需要的治疗，
together with their best companion in life.
有他们生活中最佳伴侣的陪伴。
I'm passionate to make the change
我热衷于推动改变，
and help ensure that patients, and not their disease,
帮助确保是病人，而不是他们的疾病
are in control of their lives.
在掌控他们的生活。
To me, that is health care delivered at home.
对我而言，这就是医疗护理上门服务。
Thank you.
谢谢。
(Applause)
（鼓掌）