TED@UPS
Niels van Namen: Why the hospital of the future will be your own home
尼尔斯 · 范纳曼: 为什么未来的医院在你自己家中
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1,714,555 views
没人喜欢去医院，不管是因为去那儿的路途一波三折，还是冗长的程序带来的的巨额花销，或者是耐药的超级病菌引发的并发症风险。但如果我们在家中就可以得到救命的医疗护理呢？医疗卫生未来学家尼尔斯 · 范纳曼展示了技术的进步如何能够替代住院，使家庭护理成为一种更廉价、更安全、更方便的选择。
Niels van Namen - Health care futurist
Niels van Namen leads the UPS Europe Healthcare team as the Vice President for Healthcare. Full bio
Niels van Namen leads the UPS Europe Healthcare team as the Vice President for Healthcare. Full bio
Double-click the English transcript below to play the video.
00:13
Probably not a surprise to you,
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也许你不会惊讶，
00:16
but I don't like to be in a hospital
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我不喜欢呆在医院，
00:18
or go to a hospital.
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或去医院看病。
00:20
Do you?
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你喜欢吗？
00:21
I'm sure many of you
feel the same way, right?
feel the same way, right?
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我相信你们很多人
有同样的感受，对吗？
有同样的感受，对吗？
00:24
But why? Why is it
that we hate hospitals so much?
that we hate hospitals so much?
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但为什么？为什么我们如此厌恶医院？
00:28
Or is it just a fact of life
we have to live with?
we have to live with?
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这不是生活中不可避免的一个事实吗？
00:31
Is it the crappy food?
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是难吃的病号饭？
00:34
Is it the expensive parking?
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是昂贵的停车费？
00:36
Is it the intense smell?
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是强烈的药水气味？
00:38
Or is it the fear of the unknown?
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或者是对未知的恐惧？
00:41
Well, it's all of that, and it's more.
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全部都有，而且不止这些。
00:45
Patients often have
to travel long distances
to travel long distances
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病人常常需要赶很长一段路
00:47
to get to their nearest hospital,
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才能到最近的医院，
00:50
and access to hospital care
is becoming more and more an issue
is becoming more and more an issue
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而且在美国的乡村地区
00:54
in rural areas,
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要获得医院护理
00:55
in the US,
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越来越成问题，
00:57
but also in sparsely populated
countries like Sweden.
countries like Sweden.
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在瑞典这样人口稀少的国家也是如此。
01:01
And even when hospitals are more abundant,
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即便当医院资源更加充裕时，
01:05
typically the poor and the elderly
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特别是穷人和老人也通常
01:07
have trouble getting care
because they lack transportation
because they lack transportation
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因为缺乏便利，廉价的交通
01:10
that is convenient and affordable to them.
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而无法获得医疗服务。
01:13
And many people are avoiding
hospital care altogether,
hospital care altogether,
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许多人甚至完全避开医疗治疗，
01:18
and they miss getting proper treatment
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为了节省开销而错过了
01:20
due to cost.
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合适的治疗。
01:22
We see that 64 percent of Americans
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我们可以看到，有64%的美国人
01:26
are avoiding care due to cost.
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因为费用问题而避免医疗服务。
01:30
And even when you do get treatment,
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即便你接受了治疗，
01:33
hospitals often make us sicker.
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医院也常常会让我们病情加重。
01:37
Medical errors are reported to be
the third cause of death in the US,
the third cause of death in the US,
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据报道，医疗事故是
美国的第三大致死因素，
美国的第三大致死因素，
01:43
just behind cancer and heart disease,
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仅次于癌症和心脏疾病，
01:46
the third cause of death.
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第三大死因。
01:49
I'm in health care for over 20 years now,
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我从事医疗行业已经20多年了，
01:51
and I witness every day how broken
and how obsolete our hospital system is.
and how obsolete our hospital system is.
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每天我都见证着我们的医院系统
是如此的破败和落后。
是如此的破败和落后。
01:58
Let me give you two examples.
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让我给你们两个例子。
02:00
Four in 10 Japanese medical doctors
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10个日本医生中有4个，
02:03
and five in 10 American medical doctors
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10个美国医生中有5个
02:06
are burnt out.
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已经在超负荷工作了。
02:08
In my home country, the Netherlands,
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在我的祖国，荷兰，
02:11
only 17 million people live there.
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只有1700万人口。
02:13
We are short 125,000 nurses
over the coming years.
over the coming years.
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在未来几年，我们会缺少12.5万名护士。
02:19
But how did we even end up here,
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但我们是怎么走到这一步的，
02:21
in this idea of placing
all kinds of sick people
all kinds of sick people
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把所有病人都集中到
02:24
together in one big building?
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一幢大楼里的？
02:27
Well, we have to go back
to the Ancient Greeks.
to the Ancient Greeks.
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这就要追溯到古希腊时期。
02:31
In 400 BC, temples for cure were erected
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公元前400年，人们建造了治病的庙宇，
02:34
where people could go
to get their diagnosis,
to get their diagnosis,
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病人在那里可以得到诊断，
02:36
their treatment and their healing.
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治疗和恢复。
02:39
And then really for about 2,000 years,
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在之后的2000年间，
02:42
we've seen religious care centers
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我们看到了教会的护理中心，
02:45
all the way up
to the Industrial Revolution,
to the Industrial Revolution,
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直到进入工业革命时期，
02:48
where we've seen hospitals
being set up as assembly lines
being set up as assembly lines
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我们看到医院基于工业革命的原则，
02:56
based on the principles
of the Industrial Revolution,
of the Industrial Revolution,
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像流水线那样尽快产出产品，
02:58
to produce efficiently
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提升了生产效率，
03:00
and get the products,
the patients in this case,
the patients in this case,
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在医院的案例中，产品变成了病人，
03:02
out of the hospital as soon as possible.
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以让他们尽快走出医院。
03:06
Over the last century, we've seen
lots of interesting innovations.
lots of interesting innovations.
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在过去一个世纪中，
我们看到了很多有趣的创新。
我们看到了很多有趣的创新。
03:10
We figured out how to make insulin.
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我们找到了制造胰岛素的方法。
03:13
We invented pacemakers and X-ray,
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我们发明了起搏器和X光，
03:16
and we even came into this wonderful
new era of cell and gene therapies.
new era of cell and gene therapies.
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我们甚至进入了细胞和
基因治疗的奇妙新时代。
基因治疗的奇妙新时代。
03:21
But the biggest change
to fix our hospital system altogether
to fix our hospital system altogether
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但修复我们医疗系统的最大变革
03:26
is still ahead of us.
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仍然没有到来。
03:28
And I believe it's time now,
we have the opportunity,
we have the opportunity,
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我相信现在是时候了，我们有机会
03:31
to revolutionize the system altogether
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去彻底改革整个系统，
03:34
and forget about
our current hospital system.
our current hospital system.
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完全忘掉我们现有的医院系统。
03:37
I believe it's time to create a new system
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我相信是时候创造新的，
03:39
that revolves around health care at home.
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以家庭护理为中心的系统了。
03:43
Recent research has shown
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最近的研究发现，
03:46
that 46 percent of hospital care
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46%的医院治疗
03:49
can move to the patient's home.
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可以转移到患者家中进行。
03:52
That's a lot.
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这个数量相当庞大。
03:54
And that's mainly for those patients
who suffer from chronic diseases.
who suffer from chronic diseases.
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这主要是针对那些患有慢性疾病的病人。
03:58
With that, hospitals can and should
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对此，医院可以，而且应该
04:01
reduce to smaller,
agile and mobile care centers
agile and mobile care centers
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精简到专注于急症治疗的
更加小型，灵活和移动的
更加小型，灵活和移动的
04:05
focused on acute care.
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医疗中心。
04:07
So things like neonatology,
intensive care, surgery and imaging
intensive care, surgery and imaging
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比如新生儿，重症监护，手术和成像，
04:13
will still remain at the hospitals,
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这些可以仍然保留在医院，
04:16
at least I believe
for the foreseeable future.
for the foreseeable future.
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至少在可预见的未来是这样。
04:20
A few weeks ago, I met a colleague
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几周前，我遇到一个同事,
04:22
whose mom was diagnosed
with incurable cancer,
with incurable cancer,
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她妈妈被诊断患了癌症，时日无多。
04:25
and she said, "Niels, it's hard.
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她说：“尼尔斯，真的很艰难。
04:27
It's so hard when we know
that she's got only months to live.
that she's got only months to live.
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当知道她只有几个月生命时，
一切都变得如此艰难。
一切都变得如此艰难。
04:32
Instead of playing with the grandchildren,
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她无法再和孙子们玩耍了，
04:34
she now has to travel three times a week
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现在她每周需要外出三次，
04:38
two hours up and down to Amsterdam
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经历两个小时的颠簸到阿姆斯特丹，
04:40
just to get her treatment and tests."
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就为了进行治疗和检查。”
04:43
And that really breaks my heart,
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这让我感到很伤心，
04:45
because we all know
that a professional nurse
that a professional nurse
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因为我们都知道，一个专业的护士
04:49
could draw her blood
at home as well, right?
at home as well, right?
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在家就可以进行抽血操作，对吧？
04:51
And if she could get her tests
and treatment at home as well,
and treatment at home as well,
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如果她也能在家接受治疗和检查，
04:55
she could do the things
that are really important to her
that are really important to her
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就可以利用她生命的
最后几个月做一些
最后几个月做一些
04:58
in her last months.
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真正对她重要的事情。
05:01
My own mom, 82 years old now --
God bless her --
God bless her --
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我的母亲，现在82岁了
——老天保佑她——
——老天保佑她——
05:06
she's avoiding to go to the hospital
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她不想去医院，
05:08
because she finds it difficult
to plan and manage the journey.
to plan and manage the journey.
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因为她发现很难规划和管理她的行程。
05:12
So my sisters and I, we help her out.
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于是我和妹妹会帮她搞定。
05:15
But there's many elderly people
who are avoiding care
who are avoiding care
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但有很多不去医院的老年人，
05:18
and are waiting that long
that it becomes life-threatening,
that it becomes life-threatening,
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拖的时间过长，到了危及生命的程度，
05:22
and it's straight
to the costly, intensive care.
to the costly, intensive care.
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不得不直接进入昂贵的重症监护环节。
05:26
Dr. Covinsky, a clinical researcher
at the University of California,
at the University of California,
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科文斯基博士，加州大学的临床研究员
05:30
he concludes that a third
of patients over 70
of patients over 70
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得出结论，1/3年龄超过70岁的人
05:33
and more than half of patients over 85,
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和超过一半年龄超过85岁的人，
05:36
leave the hospital more disabled
than when they came in.
than when they came in.
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离开医院时比他们进来的时候更糟糕。
05:41
And a very practical problem
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很多病人去医院
05:44
that many patients face
when they have to go to a hospital is:
when they have to go to a hospital is:
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不得不面临的一个实际问题是：
05:48
Where do I go with my main
companion in life,
companion in life,
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我和我的主要生活伴侣要去哪里，
05:52
where do I go with my dog?
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我和我的狗要去哪里？
05:57
That's our dog, by the way.
Isn't she cute?
Isn't she cute?
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这是我的狗，她是不是很可爱？
05:59
(Laughter)
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（笑声）
06:02
But it's not only about convenience.
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但这并不只跟便利有关。
06:04
It's also about unnecessary
health care stays and costs.
health care stays and costs.
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它还涉及到不必要的医疗住宿和费用。
06:09
A friend of mine, Art,
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我的一个朋友，阿特，
06:11
he recently needed to be hospitalized
for just a minor surgery,
for just a minor surgery,
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他最近需要住院接受一个小手术，
06:15
and he had to stay in the hospital
for over two weeks,
for over two weeks,
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他不得不在医院呆两个星期，
06:17
just because he needed
a specific kind of IV antibiotics.
a specific kind of IV antibiotics.
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只是因为他需要
一种特殊的静脉抗生素。
一种特殊的静脉抗生素。
06:21
So he occupied a bed for two weeks
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于是他占用了一张病床两周，
06:25
that cost over a thousand euros a day.
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每天需要花费超过1千欧。
06:27
It's just ridiculous.
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这真是荒谬。
06:29
And these costs are really
at the heart of the issue.
at the heart of the issue.
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这些费用正是问题的核心。
06:32
So we've seen over many
of our global economies,
of our global economies,
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我们看到了很多全球经济中，
06:35
health care expense grow
as a percentage of GDP
as a percentage of GDP
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医疗支出在GDP中的
占比在过去这些年
占比在过去这些年
06:38
over the last years.
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一直在增长。
06:40
So here we see
that over the last 50 years,
that over the last 50 years,
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在过去50年间，
06:43
health care expense has grown
from about five percent in Germany
from about five percent in Germany
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医疗费用占比在德国从5%
06:47
to about 11 percent now.
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上升到现在的11%。
06:50
In the US, we've seen growth
from six percent to over 17 percent now.
from six percent to over 17 percent now.
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在美国，这个比例从6%上升到17%。
06:56
And a large portion of these costs
are driven by investments
are driven by investments
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这些花费中很大部分来于
07:00
in large, shiny hospital buildings.
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对宏伟，熠熠生辉的医院建筑的投资。
07:03
And these buildings are not flexible,
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这些大楼并不灵活，
07:05
and they maintain a system
where hospital beds need to be filled
where hospital beds need to be filled
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还维持着一个需要
让医院的床位被占满，
让医院的床位被占满，
07:08
for a hospital to run efficiently.
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以保持医院效率的体系。
07:11
There's no incentive
for a hospital to run with less beds.
for a hospital to run with less beds.
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于是医院就没有动力减少床位。
07:15
Just the thought of that
makes you sick, right?
makes you sick, right?
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一想到这个你就恶心，是吧？
07:18
And here's the thing: the cost
for treating my buddy Art at home
for treating my buddy Art at home
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事实上：我的朋友阿特在家治疗的费用
07:22
can be up to 10 times cheaper
than hospital care.
than hospital care.
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要比医在院的花费便宜10倍。
07:27
And that is where we're headed.
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那就是我们前进的方向。
07:29
The hospital bed of the future
will be in our own homes.
will be in our own homes.
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医院未来的床位在我们自己的家中。
07:34
And it's already starting.
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而且这种趋势已经开始了。
07:35
Global home care is growing
10 percent year over year.
10 percent year over year.
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全球家庭护理正在以
每年10%的速度增长。
每年10%的速度增长。
07:39
And from my own experience,
I see that logistics and technology
I see that logistics and technology
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从我个人的经验来看，物流和技术
07:44
are making these home
health care solutions work.
health care solutions work.
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让家庭医疗护理变得可行。
07:48
Technology is already
allowing us to do things
allowing us to do things
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技术让我们可以做过去
07:50
that were once exclusive to hospitals.
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只有医院才能做的事情。
07:53
Diagnosis tests like blood,
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如血液，
07:56
glucose tests, urine tests, can now
be taken in the comfort of our homes.
be taken in the comfort of our homes.
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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。
现在可以在舒适的家中进行。
08:01
And more and more connected devices
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越来越多的联网设备，
08:05
we see like pacemakers and insulin pumps
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如心脏起搏器和胰岛素泵，
08:08
that will proactively signal
if help is needed soon.
if help is needed soon.
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在紧急情况下会发出预警信号。
08:12
And all that technology is coming together
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所有这些技术组合在一起
08:14
in much more insights
into the patients' health,
into the patients' health,
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可以更加深入地理解病人的健康，
08:18
and that insight and all of
the information leads to better control
the information leads to better control
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这样的剖析和所有这些信息
可以带来更好的控制，
可以带来更好的控制，
08:22
and to less medical errors --
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并减少医疗事故——
08:24
remember, the third cause of death
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记住，这可是美国第三大
08:27
in the US.
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死因。
08:29
And I see it every day at work.
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我每天都在工作中见证这些。
08:31
I work in logistics
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我工作在物流领域，
08:33
and for me, home health care works.
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对我而言，家庭医护的确可行。
08:38
So we see a delivery driver
deliver the medicine
deliver the medicine
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我们看到送货司机运输药物
08:42
to the patient's home.
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到患者家中。
08:44
A nurse joins him
and actually administers the drug
and actually administers the drug
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护士与他一道，在患者家中
08:47
at the patient's home.
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进行管理药物。
08:50
It's that simple.
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就是这么简单。
08:52
Remember my buddy, Art?
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还记得我的朋友，阿特？
08:54
He can now get the IV antibiotics
in the comfort of his home:
in the comfort of his home:
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他现在可以在舒适的家中
获得静脉注射抗生素：
获得静脉注射抗生素：
08:57
no hospital pajamas, no crappy food
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不需要穿病号服，吃难吃的病号餐，
09:01
and no risk of these
antibiotic-resistant superbugs
antibiotic-resistant superbugs
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也不会面临被只存在于
医院中的那些耐抗生素的
医院中的那些耐抗生素的
09:06
that only bite you in these hospitals.
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超级病菌叮咬的风险。
09:08
And it goes further.
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好处还不止于此。
09:10
So now the elderly people
can get the treatment that they need
can get the treatment that they need
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现在老年人也可以在他们舒适的家中
09:14
in the comfort of their own home
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获得所需要的治疗，
09:16
while with their best companion in life.
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同时有生活中最佳伴侣陪同。
09:19
And there's no need anymore
to drive hours and hours
to drive hours and hours
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也不再需要开车几个小时，
09:22
just to get your treatment and tests.
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只是为了获得医疗和检查。
09:25
In the Netherlands and in Denmark,
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在荷兰和丹麦，
我们在癌症诊所看到了
09:27
we've seen very good successes
in cancer clinics
in cancer clinics
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09:29
organizing chemotherapies
at the patient's homes,
at the patient's homes,
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在病人家中组织化疗的非常成功的例子，
09:34
sometimes even together
with fellow patients.
with fellow patients.
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有时候甚至几个病友一起。
09:38
The best improvements for these patients
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对于这些病人而言，
09:40
have been improvements
in reduction in stress,
in reduction in stress,
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最大的改善在于压力、
09:44
anxiety disorders and depression.
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焦虑障碍和抑郁的减轻。
09:47
Home health care also helped them
to get back a sense of normality
to get back a sense of normality
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家庭医护也帮助他们找回了生活中的
09:51
and freedom in their lives,
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正常和自由的感觉，
09:53
and they've actually helped them
to forget about their disease.
to forget about their disease.
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这其实也帮助他们忘记了病痛。
09:59
But home health care, Niels --
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但关于家庭医护，尼尔斯——
10:02
what if I don't even have a home,
when I'm homeless,
when I'm homeless,
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如果我没有家，当我无家可归时，
10:06
or when I do have a home
but there's no one to take care of me
but there's no one to take care of me
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或者当我有家，但没人可以照看我，
或者连开窗户都没人帮忙时怎么办？
10:09
or even open up the door?
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10:12
Well, in comes our sharing economy,
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这个时候我们的共享经济就发挥作用了。
10:15
or, as I like to call it,
the Airbnb for home care.
the Airbnb for home care.
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或者，我喜欢称之为，家庭医护爱彼迎。
10:19
In the Netherlands,
we see churches and care organizations
we see churches and care organizations
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在荷兰，我们看到教堂和护理机构
10:22
match people in need of care and company
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会将需要护理和陪伴的人们，
与有家并能提供医护
10:25
with people who actually
have a home for them
have a home for them
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和陪伴的人们进行匹配。
10:27
and can provide care and company to them.
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10:30
Home health care is cheaper,
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家庭医护更便宜，
10:32
it's easier to facilitate,
and it's quick to set up --
and it's quick to set up --
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它易于安置，可以快速投入使用——
10:36
in these rural areas we talked about,
but also in humanitarian crisis situations
but also in humanitarian crisis situations
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在这些我们谈到的农村地区，
也在人道主义危机的情况下，
也在人道主义危机的情况下，
10:40
where it's often safer, quicker
and cheaper to set things up at home.
and cheaper to set things up at home.
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把医疗设施放在家里通常
要更加安全，快速和廉价。
要更加安全，快速和廉价。
10:48
Home health care is very applicable
in prosperous areas
in prosperous areas
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家庭医护非常适用于繁荣地区，
10:52
but also very much
in underserved communities.
in underserved communities.
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但在服务水平低下的社区也是如此。
10:55
Home health care
works in developed countries
works in developed countries
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家庭护理对发达国家有效，
10:58
as well as in developing countries.
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对发展中国家也是如此。
11:00
So I'm passionate to help facilitate
improvements in patients' lives
improvements in patients' lives
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因此，我非常热衷于通过家庭医护服务
11:06
due to home health care.
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帮助改善病人的生活。
11:08
I'm passionate to help facilitate
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我热衷于帮助
11:11
that the elderly people
get the treatment that they need
get the treatment that they need
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那些老年人在自己舒适的家中
11:13
in the comfort of their own homes,
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获得所需要的治疗，
11:15
together with their
best companion in life.
best companion in life.
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有他们生活中最佳伴侣的陪伴。
11:18
I'm passionate to make the change
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我热衷于推动改变，
11:21
and help ensure that patients,
and not their disease,
and not their disease,
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帮助确保是病人，而不是他们的疾病
11:24
are in control of their lives.
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在掌控他们的生活。
11:27
To me, that is health care
delivered at home.
delivered at home.
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对我而言，这就是医疗护理上门服务。
11:30
Thank you.
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谢谢。
11:31
(Applause)
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（鼓掌）
ABOUT THE SPEAKER
Niels van Namen - Health care futuristNiels van Namen leads the UPS Europe Healthcare team as the Vice President for Healthcare.
Why you should listen
Niels van Namen has more than 20 years of experience in the health care and life science industry, working closely with customers across R&D, supply chain and manufacturing. He is passionately involved in key developments and supply chain challenges in the health care value chain; in clinical and commercial biopharmaceutical supply chains; in the complexities of medical device distribution, returns, consignments; in hospital logistics; and in final mile, home healthcare distribution and care systems. He is responsible for all health care customers and the team across all UPS business units, providing strategic direction to leverage UPS's expertise in supply chain transportation, inventory management, distribution and regulatory compliance to support healthcare companies.
van Namen started his career as an engineer and an entrepreneur in clinical trials management. He initiated Diagnostic Units, a company performing clinical trials and providing regular diagnostics and care to patients in Europe. And he worked in the IBM Healthcare consulting practice and then joined DSV to lead the global Healthcare solutions industry.
van Namen is a PDA member, holds an MSc from Delft University of Technology, obtained his MBA on the Rotterdam School of Management and holds a certificate from l'École Nationale des Ponts et Chaussées in Paris. He lives in the Netherlands, is married and has three children.
Niels van Namen | Speaker | TED.com