Mötet ekonomi och medicin : konsekvenser av nya ekonomiska styrmodeller inom sjukvården

This paper discusses current administrative reforms in the Swedish Health Care System. More specifically, changes in cost accounting, principles for resource allocation and criteria for evaluation of results in health care. Diverse and still developing models are reviewed and discussed in the light of what research in accounting, infused with constructivist social theory, has argued in later years. The reform ambitions can be categorized under two labels; panopticon and the market metaphore. Many of the well-known problems related to sophisticated management accounting seem to emerge also in the context of health care. Apart from those, we propose that health care has some intrinsic characteristics that create special problems. The social goals in terms of health, which motivate the entire system, cannot be measured in economic figures and hence not used for cost-revenue purposes, which is the base for much of management accounting. It is also problematic to apply the industrial logic of separation on medical staffs, patients, treatments and results, which intermingle in several ways in health care. Further, health care as a social field is constituted by and through the medical profession and its praxis. Medical action and discourse are based on quite different forms of categorization, judgement and values compared to management of production by economic figures. The merging of management accounting and medicine is connected both to conceptual and moral problems. The politicians and administrators pushing for administrative reforms are probably facing unintentional effects due to two factors. First, they overestimate management accounting as a means to eliminate or suppress micro-politics, opportunism and self-seeking guile. Second, they underestimate management accounting as a constituting and transforming mechanism. They adopt a traditional view that regards accounting as a neutral device, operating on a self-sufficient material world. In the long-run, the merging of management accounting and medicine can transform our conception of health and health care in ways unpredictable today.