Abstract
This paper discusses the implementation of a casemix accounting system within a large New Zealand public hospital. In the context of healthcare, casemix accounting systems are involved in attempts to increase the cost-consciousness of clinicians through the rationalization and codification of clinical activity. The paper considers the power effects of casemix accounting using a perspective that views such information and control systems as disciplinary technologies. The complex and contradictory setting of the hospital characterized by a negotiated order meant that while the casemix accounting system did appear to provide some controlling influence, it also produced forms of resistance on the part of clinicians. Our experience suggests that such systems are best thought of as making possible a new discursive space within which all organizational participants, in this case both management and clinicians, can act.
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