Abstract
This paper examines the relationship between medical and hospital accounting discourses during the two decades after the 1946 National Health Service (NHS) Act for England and Wales. It argues that the departmental costing system introduced into the NHS in 1957 was concerned with the administrative aspects of hospital costliness as contemporary hospital accountants suggested that the perceived incomparability, immeasurability and uncontrollability of medical practice precluded the application of cost accounting to the clinical functions of hospitals. The paper links these suggestions to medical discourses which portrayed the practice of medicine as an intuitive and experience-based art and argues that post-war conceptions of clinical medicine represented this domain in a manner that was neither susceptible to the calculations of cost accountants nor to calculating and normalising intervention more generally. The paper concludes by suggesting that a closer engagement with medical discourses may enhance our understanding of historical as well as present day attempts to make medicine calculable.
Highlights
Against the background of New Public Management1 reforms (Hood, 1991), the role of accounting in the public sector has changed dramatically since the early 1980s (e.g. Broadbent & Guthrie, 1992, 2008; Goddard, 2010; Hopwood & Tomkins, 1984; McSweeney, 1994)
Post-war hospital accountants and administrators portrayed clinical medicine in a manner which bore great similarities with medical discourses on the art of medicine, as discussed in Section 4 of this paper. The reasons they cited for rejecting the use of cost accounting in the clinical domain, namely the variability of patients and diseases, the immeasurable nature of clinical practice and the autonomy of medical professionals, closely resembled medical debates on the art of medicine. In light of these suggestions, this paper argues that notions of clinical medicine as an art, as articulated in medical discourses and reflected in hospital accounting discourses, played a central role in the perceived inapplicability of cost accounting to the clinical functions of hospitals during the post-war period
This paper has examined the relationship between medical and hospital accounting discourses in the early years of the National Health Service (NHS)
Summary
Against the background of New Public Management reforms (Hood, 1991), the role of accounting in the public sector has changed dramatically since the early 1980s (e.g. Broadbent & Guthrie, 1992, 2008; Goddard, 2010; Hopwood & Tomkins, 1984; McSweeney, 1994). Against the background of New Public Management reforms (Hood, 1991), the role of accounting in the public sector has changed dramatically since the early 1980s Accounting no longer “merely record[s] the activities of the state”, it has come to define, shape and constitute the objectives and activities of many public sector organisations (Hopwood, 1984: 171). The increasing prominence of accounting in the public sector had important implications for engineering, teaching and other professions that had traditionally played a central role in defining and delivering public services (cf Abbott, 1988). A range of studies have suggested that accounting came to “displace” these professions as the dominant discourses in public sector organisations like railways, utilities and schools F. Gebreiter / The British Accounting Review 48 (2016) 257e268
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