Qualitative > Quantative Research

QUALITATIVE > QUANTITATIVE RESEARCH

Introduction

This report looks at research methods including the debate between qualitative

and quantitative research methodologies, and relates these methodologies to the

healthcare field in terms of providing cost effective solutions to healthcare problems like

Medicare and other problems. The difference between qualitative and quantitative

research approaches is also highlighted in the current report in the relationship between

different paradigms of inquiry and definitions of paradigms. The features of logical

positivism and phenomenology are therefore also used in approximate relativity to

quantitative and qualitative methods, with the assumption being that qualitative methods

are more reflective of the subjective approach of phenomenology. However, the report is

also open to other definitions of paradigm and category in specific terms of healthcare

research topics and new definitions of both types of research approach. “There is no

universally accepted definition of qualitative research, because it is a field of enquiry

rather than a single entity. Qualitative research is a broad term for a variety of research

approaches… 'Qualitative research is an inquiry process of understanding based on

distinct methodological traditions of inquiry that explore a social or human problem. The

researcher builds a complex, holistic picture, analyses words, reports detailed views of

informants, and conducts the study in a natural setting” (Coates, 2004). This focus on

exploring human and social problems would seem to predispose qualitative or

phenomenological research as more appropriate for the subject of healthcare in the US,

but still, many healthcare publications do also feature logical positivist interpretations,

especially in the form of clinical trials. The report will also consider mixed

methodologies which employ elements of both phenomenology and logical positivism, or

qualitative and quantitative methods, within the same general research project in the

healthcare field.

This report will look at current issues related to costs in government health

programs under the current managed care system. Managed care is a system that has

drawbacks and advantages, depending on one’s perspective. Because it offers a wide

variety of services in a cost-effective manner, many people support managed care as a

balanced solution to healthcare. But on the other hand, other individuals state that

managed care does not in fact improve on variety when it constrains some clients in their

choice of providers, physicians, and facilities. This has led to the presentation of

different reports on this topic, with the phenomenological studies being more prevalent in

terms of criticism and solutions to current perceived problems with managed care There

are many sides to the issue, and overall, “managed care organizations have a practical

incentive to reward physicians and other health-care providers for being efficient—for

making sure that appropriate care is provided but avoiding necessary or duplicative

services… they offer the prospect of better integration of care for multiple chronic

conditions” (Atchley, p. 378). Containing Medicare costs was a part of managed care’s

original impetus. In the future, managed care will most likely expand as a system that is

more efficient as time works out some of its current imperfections, if the measures are

still being advocated in terms of foresight, and will be reflected by both qualitative and

quantitative studies.

The cause-and-effect model of logical positivism, however, or the rough

equivalent of quantitative research methods, is also very important to the existing

literature on costs in government healthcare programs. This type of relationship is

perhaps most clearly shown in terms of healthcare legislation that is passed on the basic

issues of cause and effect or perceived scientific relationships, in which the proposed

solution solves a given problem in terms of effect by eliminating the problematic cause in

some way. For example, in one healthcare study, the author states “One way state

lawmakers tackled this problem in 2004 was to enact legislation designed to promote

improved health among the nation's school-age children. Many states focused on enacting

measures that would prevent obesity among children by setting nutritional standards for

food and beverage items sold during school meals and/or limiting the items

sold through vending machines” (Plaza, 2005). This shows the logical cause and effect

relationship of positivism at work because the assumption is that the cause of obseity is

the snake machines, so eliminating this cause in a logical manner would lead to lower

rates of obestiy. A study that was more based on phenomenology would be more open to

extraneous variables, however, rather than striving for strict objectivity while maintaining

result controls. “Clearly, the view of science as an apolitical, value-free, and

disinterested search for absolute truth is romantic nonsense. Nearly 30 years ago, Ravetz

(1971) blasted the naive view of the "objective" scientist by pointing out that chemists,

biologists, and physicists have served the commercial needs of industry and the political

motives of governments for many years. Scientists, even theoretically "pure" academic

researchers, depend on contracts and grants” (Bolland, 2002). This can also be stated as

an argument regarding the political nature of a lot of debate about costs in government

healthcare programs, because the veneer of scientific objectivity is in this case clouded in

many cases by politics.

This report will look at these variables in terms of factors that show positive

directions for future healthcare research, even though some critics say that the system of

managed care is run not by concern for the customer, but by the bottom line of profits. It

is therefore not a community healthcare organization necessarily, but a consumer one.

The report will partly consider phenomenological approaches using ideals of community

healthcare. Community health care has many advantages in that it seeks to support the

whole of a society, whereas consumer health care is often about the bottom line and is

dictated by supply and demand. “It makes price, availability, accessibility and the quality

of medical care a function of free-market determination or negotiation. It grants the

doctor or the managed care organization a presumed proprietary right over medical

knowledge. The justice of the business contract requires the physician or the organization

to deliver nothing more than is owed by the conditions of the contract with the plan”

(Pellegrino, 2001). Consumer health care research also brings the research issue of

increased technology, although community implementation is sometimes problematic.

Accessibility is the key issue in the debate over healthcare. Managed care hopes to

influence the rules of supply and demand in consumer care, and Medicare provide

programs that increase accessibility for the poor, so this deals with the human issues or

phenomenology perspective.

This report will also explore the major perception that many think that healthcare

organizations need to reach out to the community in terms of educational programs that

seek to foster the health of the community as a whole, rather than treat ailments in a

specialized manner and have it end at that. Accessibility, as well as education, is an

important goal for the model healthcare program in terms of conceptual framework based

on reality. And therefore it is the assumption of this report that the issues of cost in

managed care and Medicare programs can be applied to qualitative research inquiry.

“The key principles of such inquiry are that it is conducted in a natural setting, by a

researcher who is involved in and may be a part of the data collection process, that the

data are usually in the form of words or pictures, not numbers, and that the analysis is

inductive (i.e. variables, relationships and theories are constructed after reflecting on the

data gathered rather than testing to see if the data support preestablished definitions and

theory” (Coates, 2004). Qualitative research is associated as mentioned above with

phenomenology.

Overall, this report looks at the logical positivism (quantitative) and

phenomenology (qualitative) research approaches or paradigms, examines their

theoretical underpinnings, and relates them to the healthcare setting. The specific issue at

hand is cost effectiveness in government healthcare programs such as Medicare, and how

mixed methods, qualitative, and quantitative methods apply to this setting. “Logical

positivists' response to the first criticism is that Logical Positivism, like all other

philosophies of science, is a philosophy of science, not an axiomatic system that can

prove its own consistency. (see Gödel's incompleteness theorem) Secondly, a theory of

language and mathematical logic were created to answer what it really means to say

things like "all ravens are black” (Logical, 2003). Phenomenology, on the other hand, is

more based on personal and subjective perspectives that are not so ostensibly objective or

held separate from the participant(s).

Paradigms and theoretical underpinnings

The first paradigm considered is logical positivism. This paradigm can roughly

be equated as mentioned above with the quantitative approach to research methodology.

It is a kind of research that comes from the theory that science is capable of providing

definitive and objective statements regarding the proving or disproving of hypotheses,

based on proof and deduction as well as statistics and mathematical reasoning. The

theoretical underpinnings of logical positivism go back to the early twentieth century

reliance on science and mathematical progress to solve the problems of the world, in

healthcare and other environments. And logical positivism is still very strong in

healthcare research, in terms of clinical trials and new drugs. But it is not as popular in

the areas of healthcare the include improving cost effectiveness in government programs,

because politics and science don’t traditionally tend to travel too closely. “The solution

to the heuristic versus positivistic controversy that we propose is to redefine what we

understand science to be. One solution proposed by Sir Karl Popper (1968; 1983) some

years ago. He, like Heineman Pieper, rejected naive induction as a way of verifying

scientific knowledge. Popper, in opposition to Kuhn, (see Footnote 1) argued that science

changes because one scientist finds a basis for refuting a position developed by a

previous scientist. The second scientist produces a new explanation which is then refuted,

in turn, by a third scientist, and so on” (Bolland, 2002). This idea of theories being

proven and disproven over time by multiple scientists working on it and related problems

is a strong indication of a logical positivist perspective, because it has the philosophical

underpinnings of empirically determined veracity. “The philosophy that came to

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