THE FRAMING ROLE OF ACCOUNTING IN NEW HEALTHCARE
REGULATIONS: ELEMENTS OF ANALYSIS FROM THE FRENCH AND ITALIAN CASES
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Abstract
Since the beginning of the eighties, European healthcare systems have
been experiencing a deep ongoing reform process, resorting to quasi-market
settings as a privileged regulatory means. This common framework inspired by
the New Public Management theses leads to introduce competition between
healthcare providers, were they public or private, and to shift the regulation
power to the regional health authorities, even in traditionally
hyper-centralised countries like France.
This new governance model generates increased needs for information to
support the contracting-out process. The healthcare authorities have been
developing various sets of criteria to assess both the efficiency and
effectiveness of the healthcare services provided. The paper aims at
highlighting the key role of accounting in this emerging regulation framework.
It shows how the regulatory objective leads to develop managerial accounting
techniques, urging the healthcare authorities to suggest a management control
system to the hospital sites. Although the design of DRG-based accounting
provides product tariffs required by quasi-markets, it raises problems at the
regulatory level stemming from the lack of relevance of the cost objects in
failing to capture the resource consumption processes. Some tentative solutions
have then been developed and implemented for budgetary purposes, either at the
central or at the local level, addressing the global system regulation issue.
The
analysis of the French and Italian cases, which have both adopted the US DRG
model for their quasi-market regulatory framework, helps identify the common
features of what may become the leading integrated model for both regulating
the production of healthcare services and controlling hospital sites in Europe.
An in-depth study of the reform processes shows how the introduction of
management techniques can meet the requirements of this new setting.
This work is part of a research
program entitled AREHCAS (Accounting in the Reform of European Health Care
Systems) and funded by the European Community. A earlier version of the paper
entitled “Accounting as a Key Stone of New Public Management in Healthcare: A
Comparative Analysis of the French and Italian Cases” has been accepted to the
EAA Conference in Munich, March, 2000