Niels van Namen
1,738,388 views • 11:36

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?


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.