International Circulation: Why don’t they go into cardiac rehabilitation?
　　《国际循环》：他们为什么不进行心脏康复？
　　Prof Niebauer: That’s a very good question and one I always ask. Firstly， often the staff at the acute care hospital don’t pay attention to it – they are under stress and there are many things they cannot do for their patients and the last thing they would want is a long discussion about the pros and cons of rehabilitation and where to go and so on， so they simply don’t address it. The other thing is that even though it has been offered， the patient who has been in hospital wants to get out of hospital. We all want to get out of hospital; nobody wants to stay there. Having been in hospital for a week or two， if you have to convince them to go to another hospital for three to four weeks， it usually sounds difficult and they want to go home first. Once they are home， there is nobody there to pick up the ball and take it further. It is an organizational problem that has been recognized at least by the doctors. Health insurance companies are happy about it because they don’t want to pay too much; they have no interest in sponsoring all the patients even though they all know that in the long run it will pay off. But of course it is the money that they need to put down up front that they are afraid of because， on paper， it does not show an annual return to satisfy profit evaluations but does show a return after five or ten years. The CEO has to make the investment now but the return comes too late. It is not that there is less in-hospital rehabilitation， it is more that we can see that outpatient cardiac rehabilitation is cheaper. The patient stays in their community， they stay at home and there are no costs involved other than the hours that you genuinely see someone. It is much more affordable and that is why we are also hoping in the long-term to have more outpatient rehabilitation.
　　Niebauer：这是一个很好的问题。首先，患者急诊初诊的医院工作人员对心脏康复不重视， 处在压力之下的他们有很多事情不能做到，无法解决例如患者希望讨论的有关康复的利弊和去处的问题。另一件事是，即使工作人员提供了康复的利弊和去处，但患者却希望出院。我们都希望早日离开医院，没有人愿意呆在那里，这些患者通常已经住院超过一两周，如果要说服他们前往另一家医院康复三到四周，听起来都很困难。患者们都想先回家，但一旦回到家中， 他们没有人会拿起球，并采取进一步锻炼计划。这是一个组织层面的问题，目前很多医生们已经认识到这些问题。健康保险公司对于此事非常开心，因为他们不想付出太多，即使从长远来看还是会付出这些资金也没有兴趣赞助所有的患者，保险公司害怕需要提前支付资金，因为它不显示年回报率，不能满足利润的评价，而事实上这确实可显示五年或十年后的回报，保险公司CEO现时投资，但回报来得太迟。目前，我们并没有减少院内康复，只是更多的认识到门诊心脏康复的实惠，患者在他们所在的社区、在家中，不涉及任何费用进行康复治疗，这也是为什么我们长期以来希望能有更多的门诊康复患者。
　　International Circulation: So insurance plans are more willing to pay for outpatient rehabilitation for cases they wouldn’t have paid for for inpatient rehabilitation?
　　《国际循环》：相比院内康复治疗的患者，保险公司是否更愿意支付门诊康复患者？
　　Prof Niebauer: In reality， (and now that you are looking in more detail， this may not be relevant to China)， one issue is that many of the cardiac hospitals are in fact owned by the health insurance companies， therefore it is in their best interests to have all their beds full. If you own a hospital and you make money by having patients there， why wouldn’t you want to keep your patients there rather than send them to an outpatient cardiac rehabilitation program? They will always try to fill those beds first. If the waiting list is long enough， then yes there is an increased chance they will go onto outpatient cardiac rehabilitation. What we have to do， seeing that only 20%-30% do get rehabilitation， is to target those 70%-80% not getting rehabilitation right now and for those who qualify for outpatient cardiac rehabilitation， to start programs in their neighborhood.
　　Niebauer：（更多的细节，不一定与中国相关）问题是，许多心脏专科医院实际上是医疗保险公司名下的，床位利用率高才能获得更高的利润。如果你有一家自己的医院，通过患者的住院费里用获取利润，你怎么会不想要留下院内康复患者，而将他们送到门诊心脏康复计划中呢？他们都会尽力填补这些空床位。如果轮候住院的名单足够长，患者进行门诊心脏康复的机会将更大。我们所要做的，是保证那20％-30％患者的门诊康复质量，并给予另外70％-80％有资格但没有得到康复患者进一步治疗权利，使其开始在社区内的院外康复计划。