SYNOPSIS The rising cost of healthcare is a globally pressing concern. This makes detailed attention to the way in which costing is carried out of central importance. This article offers a framework for considering the interdependencies between a dominant element of the contemporary healthcare context, i.e., Diagnosis Related Group (DRG) systems, and costing practices. DRG-based payment systems strongly influence costing practices in multiple ways. In particular, setting DRG tariffs requires highly standardized costing practices linked with specific skill sets from management accountants and brings other jurisdictions (e.g., clinical coding) to bear on costing practice. These factors contribute to the fragmentation of the jurisdiction of management accounting.

In this paper, we examine neglected dimensions of decoupling - i.e., its power and political aspects. We draw on an empirical study of the reaction of two hospital subunits and an external agency (the Regional Health Agency) to a policy implementation, to contribute to the recent renewed interest in decoupling. We first reconsider the distinction between internal and external actors by investigating how they interact in their responses to the new policy implementation. While observing different forms of decoupling, we show how power and politics allow us to understand how these forms are articulated and related. Furthermore, we highlight that contexts characterized by institutional complexity are particularly propitious for decoupling. Finally, we outline that how actors use logics to justify their claims might differ significantly from how they enact those logics. More broadly, this paper contributes by bringing back power and politics into the analysis of institutional processes.

Purpose The purpose of this paper is to examine the organizational construction of profit at the responsibility-centre level, how underlying cost calculations are challenged, and the role of accountants therein. Design/methodology/approach This paper analyses profit calculation in a public social housing organization that experienced New Public Management (NPM). Participant observations, archives and interviews inform the study over three years, enabling access to day-to-day practices. Findings This study examines a trial of strength that revisited long-existing profitability and cost calculations. Accountants held competing views of how to treat labour costs. Some were anti-programme during a trial of incompatibility, while others were programme defenders. The authors also provide evidence of the stability of an established network and its resistance to the claims of an adversary spokesperson in a trial of strength. The concept of trial of incompatibility proved helpful in showing how the actor networks within OMEGA played out the tension between profit orientation and the social mission of offering affordable dwellings. Research limitations/implications The paper provides rare qualitative data on the significant and complex role of calculative costing choices in determining intra-organizational profitability and its interference with the inherent social mission of the organization. Practical implications The authors suggest that profitability calculations are influenced not only by economic context but also by different views of organizational actors regarding how to calculate profit. These calculations would benefit from a more detailed and explicit documentation of reasons for choices made, given the potential for different and, in principle, equally valid approaches. The authors provide further evidence of the complexity of the public social housing sector. Social implications This research points to a departure from the mission of public social housing in the face of NPM reforms and further questions the compatibility of a profit orientation with the provision of affordable dwellings. Originality/value The findings show intra-accounting variation regarding a specific element of profit calculation (labour costs) relating to the organization’s wider mission and status.

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Résumé L’analyse de l’utilisation des outils du contrôle de gestion est généralement fondée sur des cadres théoriques représentationnels. Cette recherche s’inscrit dans un courant de remise en cause de ces cadres. Elle propose de considérer un outil du contrôle de gestion particulier, les indicateurs de performance (IP), dans une perspective interprétative. La théorie de l’activité est mobilisée pour proposer un modèle instrumental des IP. Les résultats de l’étude de cas mettent en évidence un processus d’appropriation des IP par les acteurs, reposant sur le concept de médiation. Cela conduit à repenser le rôle des IP dans une dynamique collective et leur contribution au pilotage et à la maîtrise des comportements.

PurposeThe purpose is to assess the impact of clinical costing approaches on the quality of cost information in seven countries (Denmark, England, France, Germany, Ireland, the Netherlands and Portugal).Design/methodology/approachCosting practices in seven countries were analysed via questionnaires, interviews and relevant published material.FindingsAlthough clinical costing is intended to support a similar range of purposes, countries display considerable diversity in their approaches to costing in terms of the level of detail contained in regulatory guidance and the percentage of providers subject to such guidance for tariff setting. Guidance in all countries involves a mix of costing methods.Research limitations/implicationsThe authors propose a two-dimensional Materiality and Quality Score (2D MAQS) of costing systems that can support the complex trade-offs in managing the quality of cost information at both policy and provider level, and between financial and clinical concerns.Originality/valueThe authors explore the trade-offs between different dimensions of the quality (accuracy, decision relevance and standardization) and the cost of collecting and analysing cost information for disparate purposes.