Casemix accounting systems: new spaces for action |
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| Institution: | 1. Dipartimento di Italianistica, Romanistica, Antichistica, Arte e Spettacolo, Università di Genova, Via Balbi 6, I-16126 Genova, Italy;2. Istituto di Studi Italiani (ISI), Università della Svizzera italiana (USI), Via Lambertenghi 10A, CH-6904 Lugano, Switzerland;1. Department of Information Management, Ling-Tung University, No.1, Ling-Tung Rd., Taichung 408, Taiwan, ROC;2. Natural Science Division in General Education Center, Ling-Tung University, No.1, Ling-Tung Rd., Taichung 408, Taiwan, ROC;3. Department of Civil Engineering, National Chung Hshin University, Taichung 402, Taiwan, ROC;4. Departmentof Civil and Environmental Engineering, University of Houston, Houston, TX, USA;5. Department of Civil Engineering, Universityof Kirkuk, Kirkuk, Iraq;1. Department of Parasitology and Medical Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran;2. Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran;3. Department of Medical Virology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran;1. School of Medicine, Flinders University, Adelaide, SA 5042, Australia;2. Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, SA 5041, Australia;3. Department of Clinical Pharmacology, Flinders Medical Centre, Adelaide, SA 5042, Australia;4. Department of Rheumatology, Repatriation General Hospital, Adelaide, SA 5041, Australia;5. Discipline of Medicine, The University of Adelaide, Adelaide, SA 5000, Australia;1. Division of General Internal Medicine, University of Pennsylvania, Philadelphia;2. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Biostatistics and Epidemiology, and Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia;3. School of Arts and Sciences, University of Pennsylvania, Philadelphia;4. Department of General Internal Medicine, University of Michigan, Ann Arbor;5. Division of General Internal Medicine, Mayo Clinic, Rochester, MN |
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| Abstract: | This paper discusses the implementation of a casemix accounting system within a large New Zealand public hospital. In the context of healthcare, casemix accounting systems are involved in attempts to increase the cost-consciousness of clinicians through the rationalization and codification of clinical activity. The paper considers the power effects of casemix accounting using a perspective that views such information and control systems as disciplinary technologies. The complex and contradictory setting of the hospital characterized by a negotiated order meant that while the casemix accounting system did appear to provide some controlling influence, it also produced forms of resistance on the part of clinicians. Our experience suggests that such systems are best thought of as making possible a new discursive space within which all organizational participants, in this case both management and clinicians, can act. |
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