MANAGEMENT ACCOUNTING CHANGE IN PUBLIC HEALTH CARE, ACTA UNIVERSITATIS OULUENSIS G Oeconomic a 65

The aim of this dissertation is to analyse the process of change in management accounting in\npublic-sector health care. The change is examined through the implementation of a nationally\nhomogeneous Diagnosis Related Grouping (DRG) system. The DRG system is used to classify\nhealth-care diagnoses into groups for service productisation and pricing. The system has been\nproposed as a solution for cost accounting and budgeting. The practical motivation of the\ndissertation is to analyse the embedding of change in organisations practises. The theoretical\nmotivation of the dissertation is to extend the investigation of change by analysing the process of\nimplementation of a nationally homogeneous system.\nThe research data comprise 39 interviews conducted between 2006 and 2011 with hospital\ndistrict representatives, the representatives of the company managing the DRG system, the DRG\nsystem supplier, and the representatives of the National Institute for Health and Welfare and the\nAssociation of Finnish Local and Regional Authorities. In addition to interviews, the data consists\nof participative observations, telephone inquiries, and newspaper articles. This dissertation\nconsists of four essays that analyse the data through the lens of two theories: the Actor Network\n(ANT) and Institutional theory (NIS).\nThe results indicate how the use of multiple theories (ANT ja NIS) as a methodology enriches\nand extends the insight into the change process in management accounting. For instance, the\nanalysis of the homogeneous use of the DRG system, without investigating the practices of actors\nby making use of the ANT, the results could have been different in this respect. Especially, this\ndissertation indicates how important it is that actors’ actions are also examined in the processes of\nchange in the implementation of public-sector management accounting systems. The idea for the\nDRG system was introduced to Finland almost twenty years ago. However, the results indicate that\nit has spread very slowly. According to earlier research, an institutional environment is considered\nto exercise pressure on organisations in order to make them adopt new practices that are\nhomogeneous with other institutional practices. There is indirect pressure in decentralised health\ncare in Finland, though its power for change is weak. This dissertation shows how the\ndecentralisation of responsibilities in large-scale institutions, such as the health-care system in\nFinland, also slows down and decentralises reforms. As institutional power becomes weaker, the\npower of organisations to promote things seems to grow stronger, however.

ISBN-10:
978-952-62-0467-3
Kieli:
eng.
Sivumäärä:
136 s.
Tekijät:
KANTOLA HANNELE
Tuotekoodi 014112
20,00 €