From book-keeping to strategic tools - Some aspects on the role of accounting in the Scandinavian Health care Sector

This paper presents some aspects of the introduction of more accountable management control in the Scandinavian hospital sector. A contingency model is used to understand the complexity of public sector government. Contextual and behavioural variables are discussed to explain the reform processes in the Scandinavian countries. Several field studies in the hospital settings show that there are similarities and differences in the implementation of the management reforms. The most striking difference is the level of central state versus local government participation in the reform processes. The reform initiative is centrally driven, but there are differences as to the use of national standard prices or pricing of services made by the hospitals themselves. Commercial-like management logic like accrual accounting is gradually introduced in all the countries, although the motives and directions of the changes are different between the countries. There is also a great variation in the interpretation of accounting information made by clinical leaders and clinical staff. The interpretation and use of accounting information should be studied more closely in the years to come, because at this level of the individual clinical actor the decisions are made about how resources are spent on hospital patient treatments.