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If, however, a plaintiff (telepatient) is injured after he or she had chosen to ignore a warning of potential danger then it is unlikely that any action for negligence brought against a defendant would succeed Similarly, if a service provider misused a telemedicine system, then he or she could not easily pass responsibility for ensuing damage to the manufacturer Finally, failure to discharge their supervisory duties adequately might also lay the MDA open to an action for negligence These comments apply mainly to operational equipment failure or malfunction but what if the fault lies in equipment design or construction Surely these faults are the responsibility of the manufacturer Well, yes and no-this is the law after all! The courts like to refer to development defects by which they mean defects that were impossible to foresee at the time the equipment was designed.



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The equipment may actually have been manufactured to this same design at a much later date in which case it may still be subject to development defects It is difficult to sustain an action against a defendant for such defects although it is incumbent on a manufacturer to revise a design in line with the latest technical (and medical) thinking, or issue an appropriate warning about restricted usage This continuing duty of care also implies that manufacturers should recall equipment that is clearly unsafe (due to faulty design or any other factor) and they would be liable to prosecution if they failed to do so..





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Allocation Effect: CAM s overweight position in a sector that performed better than the overall index (4.98% versus 3.15%) added 31 basis points to the overall value added (see Exhibit 9.18). Selection Effect: CAM s stock selection in this sector was higher than the sector return for the index, so the selection effect was a positive 17 basis points.

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The idea behind managed care is simple: those who pay the medical bills want to be sure that money is spent as efficiently as possible In a fee-for-service system this is difficult to achieve because care is determined by physicians whose pay depends on how much treatment they provide Managed care [182] has its origins in the insurance sector where the insurance companies pay the medical bills In the USA, where managed care began, these companies began to hire doctors and nurses to offer second opinions and challenge the physicians bills To counteract these challenges, doctors and hospitals began to form group practices that provided planned and cost-conscious care The insurance cover offered by these managed care organisations therefore assumes a more active role in managing their members health than traditional insurance companies, which simply acted as intermediaries in the financial transactions.

Gradually, some of the group practices evolved into health maintenance organisations (HMOs) [ 1831 that cover all necessary medical services for a fixed pre-paid fee HMOs are therefore organisations that both finance and deliver healthcare Whatever its precise form, a managed care organisation (MCO) has as its main objective the delivery of high-quality and cost-effective healthcare Telemedicine and telecare seem to offer the prospect of achieving this delicate balance [34, 1841 Quality is enhanced by the availability of expert opinion, teleconferencing between clinicians, electronic information exchange, and continuing medical education Cost effectiveness is realised by speedy billing and other electronic transactions The major driver for both quality enhancement and cost savings however, is the reduction of use and stay in hospital, and recuperation in the patient s home.

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