Reforming the reform: changing roles for accounting and management in the Italian health care sector

Abstract

This paper examines the ways in which accounting has intervened in the process of reforming the original ‘reform’ of the Italian health care system. By stepping into an ongoing process accounting has been asked not only to foster efficiency, effectiveness and value for money, but to correct as well the ‘degeneration’ of the original reform, which subjected health care delivery to ‘democratic’ scrutiny and political control. The call for a greater accountability in the use of public resources has been thus interpreted as both a mechanism of surveillance and control and a way to resist the ‘over-politicization’ of health sector management together with the abuses, scandals and fraudulent behaviour it induced. In seeking to interpret the specificity of the Italian experience, the paper suggests that the range of ‘the contexts in which accounting operates’ should be broadened in order to gain a deeper understanding of its roles in those institutions, such as health care systems, which play a crucial role in modern societies. In order to move in this direction systematic and empirically grounded cross-national comparisons are called for, since, although accounting and management are involved in virtually all attempts to redesign health care services, consequences are likely to be different when conditions of possibility differ at the outset.