Why the hospital of the future will be your own home Niels van Namen
Probably not a surprise to you,
but I don’t like to be in a hospital
or go to a hospital.
Do you?
I’m sure many of you
feel the same way, right?
But why? Why is it
that we hate hospitals so much?
Or is it just a fact of life
we have to live with?
Is it the crappy food?
Is it the expensive parking?
Is it the intense smell?
Or is it the fear of the unknown?
Well, it’s all of that, and it’s more.
Patients often have
to travel long distances
to get to their nearest hospital,
and access to hospital care
is becoming more and more an issue
in rural areas,
in the US,
but also in sparsely populated
countries like Sweden.
And even when hospitals are more abundant,
typically the poor and the elderly
have trouble getting care
because they lack transportation
that is convenient and affordable to them.
And many people are avoiding
hospital care altogether,
and they miss getting proper treatment
due to cost.
We see that 64 percent of Americans
are avoiding care due to cost.
And even when you do get treatment,
hospitals often make us sicker.
Medical errors are reported to be
the third cause of death in the US,
just behind cancer and heart disease,
the third cause of death.
I’m in health care for over 20 years now,
and I witness every day how broken
and how obsolete our hospital system is.
Let me give you two examples.
Four in 10 Japanese medical doctors
and five in 10 American medical doctors
are burnt out.
In my home country, the Netherlands,
only 17 million people live there.
We are short 125,000 nurses
over the coming years.
But how did we even end up here,
in this idea of placing
all kinds of sick people
together in one big building?
Well, we have to go back
to the Ancient Greeks.
In 400 BC, temples for cure were erected
where people could go
to get their diagnosis,
their treatment and their healing.
And then really for about 2,000 years,
we’ve seen religious care centers
all the way up
to the Industrial Revolution,
where we’ve seen hospitals
being set up as assembly lines
based on the principles
of the Industrial Revolution,
to produce efficiently
and get the products,
the patients in this case,
out of the hospital as soon as possible.
Over the last century, we’ve seen
lots of interesting innovations.
We figured out how to make insulin.
We invented pacemakers and X-ray,
and we even came into this wonderful
new era of cell and gene therapies.
But the biggest change
to fix our hospital system altogether
is still ahead of us.
And I believe it’s time now,
we have the opportunity,
to revolutionize the system altogether
and forget about
our current hospital system.
I believe it’s time to create a new system
that revolves around health care at home.
Recent research has shown
that 46 percent of hospital care
can move to the patient’s home.
That’s a lot.
And that’s mainly for those patients
who suffer from chronic diseases.
With that, hospitals can and should
reduce to smaller,
agile and mobile care centers
focused on acute care.
So things like neonatology,
intensive care, surgery and imaging
will still remain at the hospitals,
at least I believe
for the foreseeable future.
A few weeks ago, I met a colleague
whose mom was diagnosed
with incurable cancer,
and she said, “Niels, it’s hard.
It’s so hard when we know
that she’s got only months to live.
Instead of playing with the grandchildren,
she now has to travel three times a week
two hours up and down to Amsterdam
just to get her treatment and tests.”
And that really breaks my heart,
because we all know
that a professional nurse
could draw her blood
at home as well, right?
And if she could get her tests
and treatment at home as well,
she could do the things
that are really important to her
in her last months.
My own mom, 82 years old now –
God bless her –
she’s avoiding to go to the hospital
because she finds it difficult
to plan and manage the journey.
So my sisters and I, we help her out.
But there’s many elderly people
who are avoiding care
and are waiting that long
that it becomes life-threatening,
and it’s straight
to the costly, intensive care.
Dr. Covinsky, a clinical researcher
at the University of California,
he concludes that a third
of patients over 70
and more than half of patients over 85,
leave the hospital more disabled
than when they came in.
And a very practical problem
that many patients face
when they have to go to a hospital is:
Where do I go with my main
companion in life,
where do I go with my dog?
That’s our dog, by the way.
Isn’t she cute?
(Laughter)
But it’s not only about convenience.
It’s also about unnecessary
health care stays and costs.
A friend of mine, Art,
he recently needed to be hospitalized
for just a minor surgery,
and he had to stay in the hospital
for over two weeks,
just because he needed
a specific kind of IV antibiotics.
So he occupied a bed for two weeks
that cost over a thousand euros a day.
It’s just ridiculous.
And these costs are really
at the heart of the issue.
So we’ve seen over many
of our global economies,
health care expense grow
as a percentage of GDP
over the last years.
So here we see
that over the last 50 years,
health care expense has grown
from about five percent in Germany
to about 11 percent now.
In the US, we’ve seen growth
from six percent to over 17 percent now.
And a large portion of these costs
are driven by investments
in large, shiny hospital buildings.
And these buildings are not flexible,
and they maintain a system
where hospital beds need to be filled
for a hospital to run efficiently.
There’s no incentive
for a hospital to run with less beds.
Just the thought of that
makes you sick, right?
And here’s the thing: the cost
for treating my buddy Art at home
can be up to 10 times cheaper
than hospital care.
And that is where we’re headed.
The hospital bed of the future
will be in our own homes.
And it’s already starting.
Global home care is growing
10 percent year over year.
And from my own experience,
I see that logistics and technology
are making these home
health care solutions work.
Technology is already
allowing us to do things
that were once exclusive to hospitals.
Diagnosis tests like blood,
glucose tests, urine tests, can now
be taken in the comfort of our homes.
And more and more connected devices
we see like pacemakers and insulin pumps
that will proactively signal
if help is needed soon.
And all that technology is coming together
in much more insights
into the patients' health,
and that insight and all of
the information leads to better control
and to less medical errors –
remember, the third cause of death
in the US.
And I see it every day at work.
I work in logistics
and for me, home health care works.
So we see a delivery driver
deliver the medicine
to the patient’s home.
A nurse joins him
and actually administers the drug
at the patient’s home.
It’s that simple.
Remember my buddy, Art?
He can now get the IV antibiotics
in the comfort of his home:
no hospital pajamas, no crappy food
and no risk of these
antibiotic-resistant superbugs
that only bite you in these hospitals.
And it goes further.
So now the elderly people
can get the treatment that they need
in the comfort of their own home
while with their best companion in life.
And there’s no need anymore
to drive hours and hours
just to get your treatment and tests.
In the Netherlands and in Denmark,
we’ve seen very good successes
in cancer clinics
organizing chemotherapies
at the patient’s homes,
sometimes even together
with fellow patients.
The best improvements for these patients
have been improvements
in reduction in stress,
anxiety disorders and depression.
Home health care also helped them
to get back a sense of normality
and freedom in their lives,
and they’ve actually helped them
to forget about their disease.
But home health care, Niels –
what if I don’t even have a home,
when I’m homeless,
or when I do have a home
but there’s no one to take care of me
or even open up the door?
Well, in comes our sharing economy,
or, as I like to call it,
the Airbnb for home care.
In the Netherlands,
we see churches and care organizations
match people in need of care and company
with people who actually
have a home for them
and can provide care and company to them.
Home health care is cheaper,
it’s easier to facilitate,
and it’s quick to set up –
in these rural areas we talked about,
but also in humanitarian crisis situations
where it’s often safer, quicker
and cheaper to set things up at home.
Home health care is very applicable
in prosperous areas
but also very much
in underserved communities.
Home health care
works in developed countries
as well as in developing countries.
So I’m passionate to help facilitate
improvements in patients' lives
due to home health care.
I’m passionate to help facilitate
that the elderly people
get the treatment that they need
in the comfort of their own homes,
together with their
best companion in life.
I’m passionate to make the change
and help ensure that patients,
and not their disease,
are in control of their lives.
To me, that is health care
delivered at home.
Thank you.
(Applause)