Mötet ekonomi och medicin : konsekvenser av nya ekonomiska styrmodeller inom sjukvården

Abstract

This paper discusses current administrative reforms in the SwedishHealth Care System. More specifically, changes in cost accounting,principles for resource allocation and criteria for evaluation ofresults in health care. Diverse and still developing models arereviewed and discussed in the light of what research inaccounting, infused with constructivist social theory, has arguedin later years.The reform ambitions can be categorized under two labels;panopticon and the market metaphore. Many of the well-knownproblems related to sophisticated management accounting seem toemerge also in the context of health care. Apart from those, wepropose that health care has some intrinsic characteristics thatcreate special problems. The social goals in terms of health,which motivate the entire system, cannot be measured in economicfigures and hence not used for cost-revenue purposes, which is thebase for much of management accounting. It is also problematic toapply the industrial logic of separation on medical staffs,patients, treatments and results, which intermingle in severalways in health care. Further, health care as a social field isconstituted by and through the medical profession and its praxis.Medical action and discourse are based on quite different forms ofcategorization, judgement and values compared to management ofproduction by economic figures.The merging of management accounting and medicine isconnected both to conceptual and moral problems. The politiciansand administrators pushing for administrative reforms are probablyfacing unintentional effects due to two factors.First, they overestimate management accounting as a means toeliminate or suppress micro-politics, opportunism and self-seekingguile. Second, they underestimate management accounting as aconstituting and transforming mechanism. They adopt a traditionalview that regards accounting as a neutral device, operating on aself-sufficient material world. In the long-run, the merging ofmanagement accounting and medicine can transform our conception ofhealth and health care in ways unpredictable today