Management of Financial Resources in the National Health Service

Perrin, John

doi:10.1097/00004010-197904040-00012

Cited by 11 publications

(12 citation statements)

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“…A strong focus on technical efficiency and disregard for the allocative efficiency of health service outputs became a feature of all hospital costing systems adopted by the NHS since the 1950s, including the current DRG-inspired costing approach (e.g. Department of Health, 2002;Department of Health and Social Security, 1983;Perrin, 1978).…”

Section: Departmental Costingmentioning

confidence: 99%

Accounting and the ‘Insoluble’ Problem of Health-Care Costs

Gebreiter

Ferry

2016

European Accounting Review

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Health service accounting reforms are frequently promoted, explained or justified with reference to aging populations, expensive medical technologies and their purported implications for the cost of health care. Drawing on Foucault's genealogical method, we examine the emergence of concerns regarding health expenditure in the wake of the creation of the British National Health Service in 1948, and their relationship with health service accounting practices. We argue that concerns regarding the cost of health care are historically contingent rather than inescapable consequences of demographic and technological change, and that health service accounting practices are both constitutive and reflective of such concerns. We conclude by relating our analysis to current attempts to control costs and increase efficiency in the health services.

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Section: Departmental Costingmentioning

confidence: 99%

Accounting and the ‘Insoluble’ Problem of Health-Care Costs

Gebreiter

Ferry

2016

European Accounting Review

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“…Consistent with these suggestions, a number of experiments were conducted with costing systems whose aim was to provide clinically relevant cost information to doctors during the 1970s (e.g. Babson, 1973;Coles, Davison and Wickings, 1976;Russell, 1974 (DHSS, 1978;Perrin, 1978).…”

Section: Resources and Resource Allocationmentioning

confidence: 99%

Hospital accounting and the history of health-care rationing

Gebreiter

2015

Accounting History Review

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Focussing on the period from 1948 to 1997, this paper examines the history of rationing in the British National Health Service (NHS), with special reference to the role of hospital accounting in this context. The paper suggests that concerns regarding rationing first emerged in the 1960s and 1970s in response to the application of economic theories to the health services, and that rationing only became an issue of wider concern when the NHS increasingly came to resemble economic models of health services in the early 1990s. The paper moreover argues that, unlike in the US, hospital accounting did not play a significant role in allocating or withholding health resources in Britain. Rudimentary information systems as well as resistance from medical professionals are identified as significant factors in this context.

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“…Private sector property professionals who had become involved in the NHS tended to be disdainful of its standards of estate management (Pearce, 1988). Second, there was pressure from a few accounting researchers, notably from Professor John Perrin and his colleagues, for asset valuation and depreciation accounting (Perrin et al, 1978;Lapsley. 1981;Perrin, 1984).…”

Section: Capital Charging As An Incentive Mechanism In Public Healthcmentioning

confidence: 99%

“…2 This contrasted markedly with the musical chairs characteristic of the repetitive 'reorganisations' of the previous multi-tiered integrated structure. 3 Whereas the proposals of Perrin et al (1978) and Davies (1983) had not been implemented, there was now both a new impetus and an obvious requirement for capital charging as one of the pillars of the internal market. 4 …”

Section: Capital Charging As An Incentive Mechanism In Public Healthcmentioning

confidence: 99%

“…The operationalisation of such a test is inevitably bedevilled by the simultaneity of various policy and environmental changes, making it difficult to disentangle causation. There is likely to be a continuing UK debate about the effects of NHS capital charging: for example, Professor Irvine Lapsley who, as a member of the Perrin team (Perrin et al, 1978;Lapsley, 1981) can be viewed as a policy architect, has expressed doubts about what has so far been achieved (Lapsley, 1997). Nevertheless, the UK Treasury has taken encouragement from the NHS experience and capital charging will be extended to all central government assets as part of…”

Section: Experience With Capital Charging In Public Healthcare (I) Immentioning

confidence: 99%

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Capital Charging in Public Healthcare

Heald

2001

SSRN Journal

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In those OECD countries which rely most heavily upon universal public healthcare systems, a profound sense of crisis has been produced by the clash between pressures for enhanced provision and the resistance of governments to spending more. In several countries, the ideas of New Public Management have been shaping policy, with the explicit objective of improving the efficiency of resource utilisation. Healthcare systems are both labour and facilities intensive. This paper examines the way in which capital charging for publicly financed healthcare assets has been used as one mechanism within the internal market package of healthcare reform implemented in the United Kingdom in 1991. This financial innovation has been motivated by the belief that productive efficiency has been damaged by the traditional treatment of National Health Service capital as a free good. Experience with implementation has highlighted a number of issues whose full significance had not previously been appreciated, notably: the complex nature of healthcare assets; the importance of purchaser-provider separation in structuring improved incentive systems; and the greater ease of managing a system which has limited interaction with the private sector. Overall, capital charging is a valuable but flawed tool, which is much better than the asset invisibility it replaced.

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Management of Financial Resources in the National Health Service

Cited by 11 publications

References 0 publications

Accounting and the ‘Insoluble’ Problem of Health-Care Costs

Accounting and the ‘Insoluble’ Problem of Health-Care Costs

Hospital accounting and the history of health-care rationing

Capital Charging in Public Healthcare

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