ACC主席James Dove教授在即将结束其任期的时候接受了《国际循环》专访，谈了他本人对未来医疗体制改革的看法……

<International Circulation>: As you say at ACC.08 “There will be changes， and we have a professional obligation to our patients to be sure the changes are appropriate and not the ill-conceived changes made in the past few years by Medicare and the payers”， what is the aim of the CHANGES? What should we aim for? What is the first law of the improvement?

Dr. James Dove: Health care in the United States is excellent and some of the best in the world， but not everyone has access to this high quality health care.  The cost of health care in the U.S. continues to rise and there is a fear of bankrupting the system because of these escalating costs.  There are inefficiencies in care and lack of coordination of care and in some areas overuse of care but likewise there are areas within the country where the care is grossly underused.  There are 47 million uninsured Americans who have no insurance and seek their care on an emergency basis.  These patients frequently do not receive any preventive care and also many times do not seek care early enough in their illness.  It is clear that these patients have a higher morbidity and mortality rate because of that.

With the presidential elections， there are numerous discussions about providing access to care for the 47 million uninsured.  With this come also discussions around the changes in the delivery of the health care system.  The insurance company and government officials seek to control the cost of health care by simply controlling the volume and not adequately providing the resources to further improve the quality.  Full potential of quality health care in the United States will require an interconnected electronic health record where the patient has one record， no matter where they seek care within the country.  This record has the potential to further increase coordination and efficiency of health care provided in the United States.

With an interconnected health record， there is the potential to further improve the quality of care that is delivered by the use of quality improvement tools that are available at the point of care that facilitate the physician阵 decision making and adherence to guidelines and performance measures.  Designing this system requires the coordination of patients with primary care physicians and specialists and a system that provides optimal care every time in every place.  

At the American College of Cardiology Annual Meeting in Chicago， I talked about the fact that this can only be designed by physicians and patients and other health care providers and not by bureaucrats or politicians.

There are other areas that contribute significantly to the cost of health care in the United States.  A huge percentage of the health insurance premium is spent on executive salaries and profits. This amounts to as much as 120 to 180 billion dollars a year.  Those profits need to be put back into the health care system to provide improved patient care and prevention and chronic disease management.  Drug and pharmaceutical costs in the United States are much higher than they are throughout the rest of the world.  The U.S. citizens are paying for the research and development of many pharmaceutical and device companies.  These costs need to be shared equally around the world with those countries whose economies also are able to support research and development costs.  It is no longer fair for the U.S. citizens to pay higher costs for devices and pharmaceuticals at this point in the global economy.  The U.S. health care system is also troubled by an excessive litigation climate and aggressive trial lawyers who drive up the cost of health care by filing frivolous lawsuits that result in physicians practicing more defensive medicine.  In the U.S.， this accounts for 4% to 9% of the overall health care budget. The United States is the only country in the world that has this untethered legal environment. It must change.  

<International Circulation>:  What are the eras in Health Care Improvement in US and the other countries? What actions will ACC  take in the future for the CHANGES?

Dr. James Dove: The American College of Cardiology has already convened a Health System Reform Summit， which included physicians from many professional societies， patient groups， labor groups， commercial insurance， and the medical industry.  It is essential that all of these special interest groups participate in helping to redesign a system that is effective and efficient and able to deliver safe appropriate quality health care at a reasonable cost.  Nearly every health care system in the world is under the stress of increasing costs and near the brink of bankruptcy.  Many countries have responded by decreasing access to care and controlling the use of technology.  Rationing of services is not something that the U.S. citizen wants the government to do for them.   Of the 250 million Americans who have health insurance， they do not want the government interfering with the access to the care that they currently have.  ACC will continue to hold periodic Health System Reform Summits to further unify these disparate voices into a cohesive plan of action.  The American College of Cardiology intends to facilitate the development of a coalition of organizations to promote the necessary appropriate changes.  

<International Circulation>: Do your think what are the main problems faced in China health system currently? Can you give us some advises? What can we do as a physician?

Dr. James Dove: I枕 far from an expert in the Chinese Health Care System， but I suspect that there are similar problems with access to care， particularly outside the major cities.  I have also been told that there is limited insurance coverage for many Chinese citizens.  When I was in China this past October， which was my fourth trip to China， I saw enormous changes in the quality health care delivered in the major universities.  I was extremely impressed with what I saw in Shanghai and Beijing on my visit in October of 2007.  These extraordinary institutions are a foundation on which to build a quality health care system that can be disseminated throughout the rest of China.  That， too， will require coordination of care in the development of a health care system that is interconnected and delivering quality care for every patient at every encounter.  

<International Circulation>:  With the dramatic changes in the health care environment， particularly changes in technology， health care legislation， increased accountability to payers and patients， pressures in practice， we doctors need to improve more than the medical skill. What are your suggestions to the colleagues of other countries?

Dr. James Dove: Medical science continues to advance and in doing so decreases the morbidity and mortality from cardiovascular disease.  These patients go on to live more productive lives but continue to consume medical resources.  The costs， therefore， of our successes result in further increased cost of the health care system in all countries.  In many countries， including the United States， the health care system is the most rapidly growing sector within the economy.  Other than their families， people value their health more than anything else in their lives.  As medical technology continues to advance， heal