#2922 - Topic 4 Reading Experts Networks And Inscriptions In The Fabrication Of Accounting Images - Accounting in the New Public Sector

Clinicians should be able to make appropriate trade offs

• But they lack data to make theses decisions

PPS (Prospective Payment System) has led to declines in length of stay, imaging rates, number of lab tests, better prevention etc.

• Clinicians would ask at what patient cost

We can never eliminate some degree of judgement but at least we can debate on the basis of evidence and data

Quality Assurance is seen as part of administration

The production of knowledge is as much about power as it is about truth

The microcreation of accounting knowledge and its practice is both constituted by and constitutes social and power relations in a post-industrial age characterized by a “mode of information” (Poster, 1990)

Define “the” output of product of a hospital via its casemix

• This notion is similar to the manufacturing concept of volume mix

Casemix seeks to measure a hospital’s output in a defined period in terms of the number and type of cases (patients) treated

A discourse about DRG-based accounting, that is, the allocation of accounting costs to individual DRGs for internal budgetary and managerial control purposes, did not arise until the late 1970s and 1980s (e.g. Fetter el al., 1976)

• DRG accounting software embodies the Yale Cost Model (YCM)

Must appreciate that DRG generation is very different to DRG-based accounting

• DRG casemixes are statistically generated

The Universities projects were:

• 1) The development of casemix accounting and costing systems using the YCM

• 2) The development of non-financial casemix management information systems and utilization review

• 3) The investigation of organizational change, new organizational structures which were appropriate for casemix management and the development of educational packages

In the 1970s, government agencies came to be perceived as ineffectual and too big and became the subject of extensive reviews

• E.g. The Bland Inquiry of 1973-1975 in Victoria spoke of major administrative staffing deficiencies, outmoded attitudes and a lack of initiative

In 1975, a reformist Labour Commonwealth government created Medibank, a universal health coverage scheme

• Changed somewhat over the years

• Still exists today as a universal, state-financed, health coverage modified as the Medicare system

The generation of product cost information became a key “interessement” device, which would tie together the interests of the different stakeholders

Knowing more accurately what their products were and how much they cost could help hospital administrators to manage with less, and possibly get more from the government

The support for DRG-based accounting by hospital managers depends on their background

Transplanted knowledge (the American DRGs) to be modified to local conditions

To achieve victory, new converts would need to be forms, critics silenced, competitors overcome, sceptics convinced and the technology shown to work in many, diverse workplaces

Latour (1987) points out, the fate of a technology does not lie in the hands of designers or initial supports but with those who come after – actors, who are often possessed of different interests and subject to different pressures

Some hospital personnel were not convinced that DRGs could be sold at a particular time (especially to doctors)

• The casemix itself was a notion that was relatively new to the hospital world

Perhaps...