In this way, any concerns that could come up and be problematic will be avoided and the information contained in the study can be accepted as being reliable, valid, and unique.
As has been mentioned, limitations are too often overlooked in studies, and it is often impossible to find all of the limitations that are contained in a study and spell them out for all to see. However, that does not mean that the limitations that are noticed should be overlooked. As long as they are legitimate, the more limitations that are discussed in the research the more significant the research will be found to be, since any weaknesses that it might have will be noted and dealt with. It is for this reason that this particular section will detail the limitations that this study faces.
The main limitation of this study, other than the biases of the researcher, is that the study is largely subjective. Some may not see this as a limitation, but others will view it that way, and so it is important to discuss it and clear up any concerns early on. Objective studies are analytical and deal with facts and figures. Subjective studies deal more with perceptions and feelings, as well as thoughts and beliefs. While both are good ways of studying things, the kind of study that is being performed often dictates which way the study is conducted.
For this particular study, being able to be objective and provide facts and figures about the doctors, MCOs, and incentives would have been good, and could have provided some very significant data that would be important for future study. However, when dealing with concerns like this where individuals answer surveys, and where the literature review is also used as part of the collected data, there are often few facts and figures that can be used and relied on with any degree of certainty. This is why the study is subjective - not because there are no figures provided, but because the figures provided are based on answers to Yes/No questions, and these types of answers are largely subjective and based on the perceptions of the individual answering the survey. As has been mentioned, not all will see this as a limitation or a weakness of the study, but it is mentioned here so those that do view it that way will be aware of it.
Assumptions
The assumption of this research is to establish that there is a relationship between physician behavior and the monetary incentives used by MCOs. A further assumption is that physicians do see this as an ethical problem. If a physician limits the amount of hospital admissions, testing, and specialist referrals, that physician can financially gain, but at what cost to the patient? At what cost to the moral and ethical code of the physician? These questions are at the root of the problem, and must be considered and analyzed.
Hypothesis
The main hypothesis of this research is that physicians do limit what they do for their patients when they see that they will achieve financial gain in this manner, and that this is detrimental to the care quality that these patients receive.
Managed care has had such a huge impact on both physicians and patients that many have not stopped to consider that, even though it may be financially better, the quality of patient care may not be the same as it was in the fee-for-service days, when the words 'managed care organization' were meaningless. The relationship between a physician and his or her patient is the foundation for modern medical ethics (LaPuma, 1996). To compromise that relationship to save a few dollars is terrifying, but it may be exactly what MCOs are doing. Clearly, there is a large ethical question here that necessitates further analysis.
In order to identify and consider the problem, various collected research articles have been examined, and can be found in the literature review that follows. Data sources under consideration came from the Kaiser Family Foundation, the AMA Council on Ethical and Judicial Affairs, and various academic journals. The summary of these relevant arguments, as well as the theoretical implications that could be found in them, allowed for some very important conclusions to be drawn about MCOs, physicians, and the ethical questions that they battle on a daily basis.
Chapter Two - Literature Review
In order to fully understand the literature being reviewed, it is important to understand the term 'care quality'. It will be defined in this section....
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