Understanding the behavioural aspects of costing systems in public health organisations

The paper reports on a case study of the processes behind the development and the implementation of a centre-based costing system in a public health organisation. Since the processes of change involve the activities of various groups, the paper explores the reformers' policies towards public health organisations and, at the same time, the actions of actors within one of those organisations towards these policies. The paper explains how new practices, mainly costing practices, emerge and intermediate between reformers' policies and organisational members' way of thinking. It uses Giddens' (1984, 1990b) structuration theory, as a sensitising device, to understand the behavioural aspects behind the development and implementation of these costing practices. The findings reveal that reformers draw on their experience of costing techniques at the public industrial sector. They also draw on the knowledge they obtained through their connection with international consultant firms specialised in healthcare reform. Other organisational members draw on different stock of knowledge to bring different perspectives to the issue of costing. Physicians draw on their professional expertise, accountants draw on their prior experience of budgetary control and both draw on their mutual understanding of their organisation as a public free healthcare institution.