TED@Merck KGaA, Darmstadt, Germany
Matthias Müllenbeck: What if we paid doctors to keep people healthy?
马提亚斯·穆兰贝克: 如果我们付钱给医生，让他们保持人民的健康，听起来如何？
Filmed:
Readability: 6.1
1,479,013 views
如果我们奖励医生保持我们健康，而不是只在我们生病时才付钱给他们，这样听起来如何？马提亚斯·穆兰贝克解释了这项从“疾病诊治”体制转变为真正的“健康维护”体制的根本改变，如何能帮我们节省不必要的花销和高风险的手术，并让我们更健康、长寿。
Matthias Müllenbeck - Business developer
As the Biopharma director for licensing and business development at Merck KGaA, Darmstadt, Germany, Matthias Müllenbeck is responsible for leading strategic partnering initiatives in the field of oncology and immuno-oncology. Full bio
As the Biopharma director for licensing and business development at Merck KGaA, Darmstadt, Germany, Matthias Müllenbeck is responsible for leading strategic partnering initiatives in the field of oncology and immuno-oncology. Full bio
Double-click the English transcript below to play the video.
00:12
It's 4am in the morning.
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时间是凌晨四点。
00:16
I'm waking up in a Boston hotel room
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我在波士顿一间
酒店的客房中醒来，
酒店的客房中醒来，
脑中只能想着一件事：
00:18
and can only think of one thing:
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00:21
tooth pain.
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牙痛。
00:24
One of my ceramic inlays
fell off the evening before.
fell off the evening before.
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前一晚，我的一个瓷镶体脱落了。
00:27
Five hours later,
I'm sitting in a dentist's chair.
I'm sitting in a dentist's chair.
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五小时之后，我坐在牙科的椅子上。
但牙医并没有修复我的瓷镶体，
好让我脱离牙痛之苦，
好让我脱离牙痛之苦，
00:31
But instead of having a repair of my inlay
so that I can get rid of my pain,
so that I can get rid of my pain,
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反而在跟我推销
钛植牙手术的优点。
钛植牙手术的优点。
00:36
the dentist pitches me on the advantages
of a titanium implant surgery.
of a titanium implant surgery.
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00:42
Ever heard of that?
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有听过吗？
（笑声）
00:43
(Laughter)
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基本上，就是要把一颗受损的牙齿
00:45
It essentially means to replace
a damaged tooth
a damaged tooth
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换成一颗人工牙齿，
00:49
by an artificial one,
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用螺钉固定在你的下颌上。
00:50
that is screwed into your jaw.
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00:53
Estimated costs for the implant surgery
may add up to 10,000 US dollars.
may add up to 10,000 US dollars.
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植牙手术的估计花费
可能会高达一万美金。
可能会高达一万美金。
00:59
Replacing the ceramic inlay I had before
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但把我之前的瓷镶体换掉，
只要大约一百美元。
01:02
would come in at 100 US dollars.
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01:06
Was it my health or the money
that could be earned with me
that could be earned with me
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到底是我的健康，
还是能从我身上赚到的钱，
还是能从我身上赚到的钱，
01:10
that was the biggest concern
for my dentist?
for my dentist?
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是我的牙医最先考虑的事？
01:13
As it turned out, my experience
wasn't an isolated case.
wasn't an isolated case.
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结果发现，我的经历并非个案。
01:18
A study by a US national newspaper
estimated that in the United States,
estimated that in the United States,
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美国一家全国性报纸的研究指出，
在美国所有的手术当中，
在美国所有的手术当中，
大约有三成——
01:24
up to 30 percent of all
surgical procedures --
surgical procedures --
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包括支架和心律调节器植入、
01:27
including stent
and pacemaker implantations,
and pacemaker implantations,
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髋关节置换，及子宫移除——
01:31
hip replacements and uterus removals --
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被实施，
01:34
were conducted
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尽管其他非手术的
治疗方式尚未完全
治疗方式尚未完全
01:35
although other nonsurgical treatment
options had not been fully exploited
options had not been fully exploited
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被其主治医生采用过。
01:39
by the physician in charge.
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01:43
Isn't that figure shocking?
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那数字不是挺吓人的吗？
01:45
Numbers may be slightly different
in other countries,
in other countries,
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在其他国家，数字可能稍有不同，
但这意味着，如果你在美国看医生，
01:48
but what it means is that
if you go to a doctor in the US,
if you go to a doctor in the US,
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你有极大的可能性，
会在不立即需要手术的情况下
会在不立即需要手术的情况下
01:52
you have a not-insignificant chance
to be subjected to a surgical intervention
to be subjected to a surgical intervention
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被要求进行手术治疗。
01:57
without there being
an immediate need for it.
an immediate need for it.
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02:00
Why is this?
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为什么会这样？
02:02
Why are some practitioners incentivized
to run such unnecessary procedures?
to run such unnecessary procedures?
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为什么有些从业医生
会被鼓励去做这类不必要的手术？
会被鼓励去做这类不必要的手术？
02:09
Well, perhaps it is because
health care systems themselves
health care systems themselves
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也许是因为医疗体制本身，
用一种不尽理想的方式，
02:14
incentivize in a nonideal way
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鼓励采用，或不采用
某些手术或治疗。
某些手术或治疗。
02:17
towards applying or not applying
certain procedures or treatments.
certain procedures or treatments.
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02:21
As most health care systems
reimburse practitioners
reimburse practitioners
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大部分的医疗系统
对从业医生的补助
对从业医生的补助
02:24
in a fee-for-service-based fashion
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是以按次付费的医疗费为基础的，
根据治疗的数量和类型来付款，
02:27
on the number and kind
of treatments performed,
of treatments performed,
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可能就是这种经济上的奖励
诱使一些从业医生
诱使一些从业医生
02:30
it may be this economic incentive
that tempts some practitioners
that tempts some practitioners
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选择采用高利润的手术治疗，
02:34
to rather perform high-profit
surgical treatments
surgical treatments
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而不去寻求其他治疗方案。
02:37
instead of exploring
other treatment options.
other treatment options.
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02:40
Although certain countries
started to implement
started to implement
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虽然有些国家开始导入
以绩效为基础的补助，
02:43
performance-based reimbursement,
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综合考虑治疗的质量和效率，
02:45
anchored on a quality and efficacy matrix,
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02:48
overall, there's very little in today's
health care systems' architecture
health care systems' architecture
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整体来说，现今的医疗
系统结构中，很少会有某种方式，
系统结构中，很少会有某种方式，
广泛鼓励开业医生
02:52
to incentivize practitioners broadly
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在一开始就主动预防疾病出现，
02:54
to actively prevent the appearance
of a disease in the first place
of a disease in the first place
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02:58
and to limit the procedures
applied to a patient
applied to a patient
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并只对病人进行
效果最佳的手术。
03:01
to the most effective options.
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03:03
So how do we fix this?
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这问题要如何解决呢？
03:07
What it may take is a fundamental redesign
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可能会需要从根本上重新设计
我们的医疗系统结构——
03:10
of our health care
system's architecture --
system's architecture --
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完全重新思考激励性的结构。
03:12
a complete rethinking
of the incentive structure.
of the incentive structure.
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03:16
What we may need is a health care system
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我们需要把医疗系统的补助条件
改成是医生要保持其客户的健康，
03:18
that reimburses practitioners
for keeping their customers healthy
for keeping their customers healthy
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而不是几乎只支付
已患病之后的治疗服务。
已患病之后的治疗服务。
03:22
instead of almost only paying for services
once people are already sick.
once people are already sick.
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03:28
What we may need is a transformation
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我们需要转变，
03:31
from today's system
that largely cares for the sick,
that largely cares for the sick,
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从现今主要的治疗疾病的体制，
03:34
to a system that cares for the healthy.
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转变为预防疾病的体制。
03:38
To change our current "sick care" approach
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把我们目前的“疾病诊治”方法，
改变为真正“健康维护”方法。
03:41
into a true "health care" approach.
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03:44
It is a paradigm shift from treating
people once they have become sick
people once they have become sick
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这是一种示范性的转移，
从在大家生病之后才进行治疗，
从在大家生病之后才进行治疗，
变成在他们生病之前
努力维持他们的健康。
努力维持他们的健康。
03:49
to preserving the health of the healthy
before they get sick.
before they get sick.
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03:53
This shift may move the focus
of all those involved --
of all those involved --
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这种转移，可能会让
所有相关群体的焦点发生改变——
所有相关群体的焦点发生改变——
03:57
from doctors, to hospitals,
to pharmaceutical and medical companies --
to pharmaceutical and medical companies --
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医生、医院、药厂，
及医疗器材公司——
及医疗器材公司——
把重心转移到这个产业
最终要销售的产品上：
最终要销售的产品上：
04:02
on the product that this industry
ultimately sells:
ultimately sells:
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04:07
health.
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健康。
04:09
Imagine the following.
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想像以下情况。
04:12
What if we redesign our health care system
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如果我们重新设计医疗系统，
这个系统不会对于病人
04:15
into one that does not
reimburse practitioners
reimburse practitioners
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实际上执行的手术而补助从医者，
04:18
for the actual procedures
performed on a patient
performed on a patient
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而是让医生、医院、
04:20
but rather reimburses doctors, hospitals,
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药厂，以及医疗器材公司，
04:23
pharmaceutical and medical companies
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确保每天每一个病人能健康无疾病，
04:26
for every day a single
individual is kept healthy
individual is kept healthy
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就能得到补助？
04:29
and doesn't develop a disease?
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04:31
In practical terms, we could, for example,
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从实践的角度来说，比如，我们可以
用公款来支付健康费给保险公司，
04:34
use public money to pay a health fee
to an insurance company
to an insurance company
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只要每天每一个人能保持健康
04:38
for every day a single individual
is kept healthy
is kept healthy
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无疾病，
04:41
and doesn't develop a disease
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或是不需要任何
其他形式的急性医疗干预就付款。
其他形式的急性医疗干预就付款。
04:42
or doesn't require any other form
of acute medical intervention.
of acute medical intervention.
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04:47
If the individual becomes sick,
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如果一个人生了病，
保险公司不会从治疗
所需要进行的医疗干预中
所需要进行的医疗干预中
04:49
the insurance company will not receive
any further monetary compensation
any further monetary compensation
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收到任何进一步的金钱补助，
04:54
for the medical interventions required
to treat the disease of that individual,
to treat the disease of that individual,
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04:58
but they would be obliged to pay
for every evidence-based treatment option
for every evidence-based treatment option
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他们反而有义务要支付
让客户恢复健康的治疗选择，
让客户恢复健康的治疗选择，
05:02
to return the customer back to health.
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只要能够证明治疗的必要性。
05:05
Once the customer's healthy again,
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一旦客户再次恢复健康，
他们就会再次收到那个人的健康费。
05:07
the health fee for that individual
will be paid again.
will be paid again.
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05:11
In effect, all players in the system
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实际上，在这个体制中的所有参与者
现在都有责任要保持客户健康，
05:14
are now responsible for keeping
their customers healthy,
their customers healthy,
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他们若能避免不必要的
医疗干预，就能得到奖励，
医疗干预，就能得到奖励，
05:17
and they're incentivized to avoid
any unnecessary medical interventions
any unnecessary medical interventions
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只要做到减少生病的人数。
05:22
by simply reducing the number of people
that eventually become sick.
that eventually become sick.
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05:28
The more healthy people there are,
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大家越健康，
05:31
the less the cost
to treat the sick will be,
to treat the sick will be,
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治疗疾病的成本就会越低，
05:35
and the higher the economic benefit
for all parties being involved
for all parties being involved
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而保持每位客户健康的相关各方，
也会有更高的经济利益。
05:39
in keeping these individuals healthy is.
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05:43
This change of the incentive
structure shifts, now,
structure shifts, now,
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将奖励结构做这种改变
会转移整个医疗体制的注意力，
05:45
the attention of the complete
health care system
health care system
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从专注在提供独立
且单一的治疗选择，
且单一的治疗选择，
05:48
away from providing isolated
and singular treatment options,
and singular treatment options,
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转变成从整体的角度关注要做什么，
05:52
towards a holistic view of what is useful
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才能让人保持健康和长寿。
05:55
for an individual
to stay healthy and live long.
to stay healthy and live long.
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06:00
Now, to effectively preserve health,
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若要有效地保持健康，
大家需要愿意，并且经常分享
06:04
people will need to be willing
to share their health data
to share their health data
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他们的健康数据，
06:07
on a constant basis,
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这么一来，医疗系统就能及时
06:09
so that the health care system
understands early enough
understands early enough
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了解大家保持健康
需要什么样的协助。
需要什么样的协助。
06:12
if any assistance with regard
to their health is needed.
to their health is needed.
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06:16
Physical examination,
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体检、
监控终身健康数据，
06:18
monitoring of lifetime health data
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还有DNA测序、心血管代谢分析，
06:20
as well as genetic sequencing,
cardiometabolic profiling
cardiometabolic profiling
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以及成像相关的技术，
06:25
and imaging-based technologies
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06:27
will allow customers to make,
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会让客户配合健康教练
06:28
together with health coaches
and general practitioners,
and general practitioners,
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和广大从业医生，
06:32
optimal and science-guided decisions --
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做出由科学引导的最佳决策——
包括饮食、用药，
以及身体活动相关的决策——
以及身体活动相关的决策——
06:34
for their diet, their medication
and their physical activity --
and their physical activity --
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以降低每个人得到
06:39
to diminish their unique probability
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每种可认定的高风险疾病的机率。
06:41
to fall sick of an identified,
individual high-risk disease.
individual high-risk disease.
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06:47
Artificial intelligence-based
data analysis
data analysis
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以人工智能为基础的数据分析
以及传感器技术的微型化，
06:49
and the miniaturization
of sensor technologies
of sensor technologies
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已经开始让监控
个人健康状况成为可能。
个人健康状况成为可能。
06:51
are already starting to make monitoring
of the individual health status possible.
of the individual health status possible.
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06:57
Measuring cardiometabolic parameters
by devices like this
by devices like this
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用像这样的装置来
测量心血管代谢参数，
测量心血管代谢参数，
07:01
or the detection of circulating
tumor DNA in your bloodstream
tumor DNA in your bloodstream
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或赶在癌症袭击之前
就先检测你的血液中
就先检测你的血液中
有无血液循环肿瘤DNA，
07:04
early on after cancer disease onset
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只是这类监控技术的
两个例子而已。
两个例子而已。
07:07
are only two examples
for such monitoring technologies.
for such monitoring technologies.
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07:11
Take cancer.
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比如癌症。
07:13
One of the biggest problems
in certain oncological diseases
in certain oncological diseases
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（治疗）某些肿瘤疾病遇到
最大的问题之一，
最大的问题之一，
就是太多病人都太晚才确诊，
07:16
is that a large number of patients
is diagnosed too late
is diagnosed too late
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已经来不及治愈，
07:20
to allow them to be cured,
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尽管现今已经有些
药品和治疗手段
药品和治疗手段
07:22
although the drugs and treatments
that could potentially have cured them
that could potentially have cured them
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有可能治愈他们，
07:25
are already existing today,
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只要疾病能更早被筛查出来。
07:27
if the disease had only
been detected earlier.
been detected earlier.
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07:31
New technologies allow now,
based on a few milliliters of blood,
based on a few milliliters of blood,
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最新的技术已经能
根据几毫升的血液
根据几毫升的血液
检测出是否有
血液循环肿瘤DNA，
血液循环肿瘤DNA，
07:35
to detect the presence
of circulating tumor DNA
of circulating tumor DNA
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因此，在早期就能用
07:37
and thus, the presence of cancer,
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很方便的方式检测出癌症。
07:39
early on in a really convenient manner.
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07:42
The impact that this early-stage
detection can have
detection can have
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这种早期检测会造成的影响
07:46
may be dramatic.
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是非常巨大的。
07:48
The five-year survival rate
for non-small cell lung cancer
for non-small cell lung cancer
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非小细胞肺癌的五年存活率，
如果在第一期，也就是很早期
就诊断出来，五年存活率是49%。
就诊断出来，五年存活率是49%。
07:52
when diagnosed at stage one,
which is early, is 49 percent.
which is early, is 49 percent.
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07:58
The same, when diagnosed
at stage four, which is late,
at stage four, which is late,
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如果在第四期，
也就是晚期才诊断出来，
也就是晚期才诊断出来，
08:03
is below one percent.
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五年存活率就不到1%。
08:06
Being potentially able
to prevent a large number of deaths
to prevent a large number of deaths
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只要用很简单的东西，
比如血液循环肿瘤DNA的血液检测，
比如血液循环肿瘤DNA的血液检测，
就有可能防止许多人因此丧命，
08:10
by something as simple as a blood test
for circulating tumor DNA
for circulating tumor DNA
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它能让某些类型的
癌症变成可以控制的疾病，
癌症变成可以控制的疾病，
08:15
could make certain cancer types
a manageable disease,
a manageable disease,
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疾病的发生能及早被检测出来，
08:18
as disease onset can be detected earlier
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08:21
and positive treatment outcomes
can likely be increased.
can likely be increased.
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因此也更可能会有正面的治疗结果。
08:27
In 2012,
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2012年，
08:30
50 percent of all Americans
had a single chronic disease,
had a single chronic disease,
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有50%的美国人得了单一种慢性病，
导致美国三万亿美元的
医疗预算中有86%
医疗预算中有86%
08:34
resulting in 86 percent
of the $3 trillion US health care budget
of the $3 trillion US health care budget
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花在治疗这类慢性病上。
08:40
being spent for treating
such chronic diseases.
such chronic diseases.
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08:44
Eighty-six percent.
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86%。
08:48
If new technologies allow now
to reduce this 86 percent,
to reduce this 86 percent,
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如果新技术能减低这86%，
为什么医疗体系
还没有做出应对和改变？
还没有做出应对和改变？
08:53
why have health care systems
not reacted and changed already?
not reacted and changed already?
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08:58
Well, a redesign of what today
is a sick care system
is a sick care system
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要把现今的疾病治疗体系
重新设计成真正的
聚焦在预防和行为改变上的
聚焦在预防和行为改变上的
09:03
into a true health care system
that focuses on prevention
that focuses on prevention
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预防性医疗体系，
09:07
and behavioral changes
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这需要体制中的
每个行为者都做出改变。
每个行为者都做出改变。
09:08
requires every actor
in the system to change.
in the system to change.
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09:12
It requires the political willingness
to shift budgets and policies
to shift budgets and policies
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这也需要政治意愿将预算和政策
转向预防和健康教育，
09:16
towards prevention and health education
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09:18
to design a new set of financial
and non-financial incentives.
and non-financial incentives.
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来设计一组新的经济
和非经济上的奖励方式。
和非经济上的奖励方式。
09:22
It requires creating
a regulatory framework
a regulatory framework
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这就需要创造一个规范的构架，
来收集、使用和分享个人健康数据，
09:25
for the gathering, using and sharing
of personal health data
of personal health data
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严格且合理的规范构架。
09:30
that's at the same time
stringent and sensible.
stringent and sensible.
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09:33
It needs doctors, hospitals, insurers,
pharmaceutical and medical companies
pharmaceutical and medical companies
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这需要医生、医院、保险从业者、
药厂，以及医疗器材公司
药厂，以及医疗器材公司
重新调整他们的方法，
而且，最重要的是，
而且，最重要的是，
09:37
to reframe their approach
and, most important,
and, most important,
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这件事若要成真，
需要依靠每个人都有
需要依靠每个人都有
09:41
it can't happen without
the willingness and motivation
the willingness and motivation
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意愿和动机去改变他们的
生活方式，变得更可持续，
生活方式，变得更可持续，
09:45
of individuals to change their lifestyle
in a sustained way,
in a sustained way,
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把保持健康列为优先事项，
09:49
to prioritize staying healthy,
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此外还要能开放地
经常分享健康数据。
经常分享健康数据。
09:51
in addition to opening up for sharing
the health data on a constant basis.
the health data on a constant basis.
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09:56
This change may not come overnight.
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这种改变不会一夕成真。
但现在就行动，在医疗产业中
将奖励的焦点转变为
将奖励的焦点转变为
09:58
But by refocusing the incentives
within the health care industry today
within the health care industry today
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主动保持民众健康，
10:03
to actively keep people healthy,
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我们不但能在一开始
就先预防更多的疾病，
就先预防更多的疾病，
10:05
we may not only be able to prevent
more diseases in the first place
more diseases in the first place
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也能够检测出
某些可预防之疾病的发生，
某些可预防之疾病的发生，
10:09
but we may also be able to detect
the onset of certain preventable diseases
the onset of certain preventable diseases
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且比现今能做到的更早，
10:13
earlier than we do today,
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这就会让更多人
能更长寿、更健康。
能更长寿、更健康。
10:15
which will lead to longer
and healthier lives for more people.
and healthier lives for more people.
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10:20
Most of the technologies
that we need to initiate that change
that we need to initiate that change
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要开始这项改变，
我们所需要的技术
我们所需要的技术
大多已经存在了。
10:23
are already existing today.
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10:25
But this is not a technology question.
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但这不是个技术问题。
10:27
It is primarily a question of vision
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根本上讲，这是个远见，
10:31
and will.
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以及意愿的问题。
10:33
Thanks a lot.
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非常感谢。
（掌声）
10:34
(Applause)
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Translated by Echo Sun
ABOUT THE SPEAKER
Matthias Müllenbeck - Business developerAs the Biopharma director for licensing and business development at Merck KGaA, Darmstadt, Germany, Matthias Müllenbeck is responsible for leading strategic partnering initiatives in the field of oncology and immuno-oncology.
Why you should listen
Throughout his career in various roles at Merck KGaA, Darmstadt, Germany, Matthias Müllenbeck worked on strategic asset, technology and diagnostic-licensing deals and on bringing to market innovative chemical products. He holds a PhD in immunology from the Humboldt University in Berlin and has worked at the Max-Planck Institute for infection biology in Berlin, at Bayer, and at the Albert-Schweizer Hospital in Lambarané, Gabon.
Matthias Müllenbeck | Speaker | TED.com