This study reviews 317 accounting studies in health care from the past 40 years. In addition to a traditional description of the theory and methods applied, this review focuses on the countries that have been studied, the stakeholder perspectives that have been represented through data collection and the longitudinal accounting topic focuses that have been developed. The findings illuminate trends and gaps in the literature. Specifically, this study identifies a growing trend of applying interviews as a method of data collection, which increases the possibility of representing individual stakeholders. Predominantly, administrators’ and doctors’ viewpoints are presented, whereas a lack of perspectives among nurses, patients, and politicians raises opportunities for future research. Additionally, there has been an increase in the number of countries represented in studies. Whereas Scandinavian countries are well represented in this literature review, studies of non‐English‐speaking countries are still significantly lacking. The accounting topic in focus has seen a natural development with New Public Management (NPM) reform developments. A majority of costing and budgeting studies in the 1980s and 1990s have gradually changed to a performance measure focus and different atypical areas, signaling increased nuances in the role of accounting in the health care sector. Thus, although the majority of the existing accounting literature has focused on NPM market reforms, NPM health care reform is far from exhausted, and ample opportunities exist for future research in health care accounting.
Maryland implemented one of the most aggressive payment innovations the nation has seen in several decades when it introduced global budgets in all its acute care hospitals in 2014. Prior to this, a pilot program, total patient revenue (TPR), was established for 8 rural hospitals in 2010. Using financial hospital report data from the Health Services Cost Review Commission from 2007 to 2013, we examined the hospitals' financial results including revenue, costs, and profit/loss margins to explore the impact of the adoption of the TPR pilot global budget program relative to the remaining hospitals in the state. We analyze financial results for both regulated (included in the global budget and subject to rate-setting) and unregulated services in order to capture a holistic image of the hospitals' actual revenue, cost and margin structures. Common size and difference-in-differences analyses of the data suggest that regulated profit ratios for treatment hospitals increased (from 5% in 2007 to 8% in 2013) and regulated expense-to-gross patient revenue ratios decreased (75% in 2007 and 68% in 2013) relative to the controls. Simultaneously, the profit margins for treatment hospitals' unregulated services decreased (- 12% in 2007 and - 17% in 2013), which reduced the overall margin significantly. This analysis therefore indicates cost shifting and less profit gain from the program than identified by solely focusing on the regulated margins.
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