Accounting research on health care – Trends and gaps

• Author: Margit Malmmose
• DOI: http://doi.org/10.1111/faam.12183
• Date: 01 February 2019
• Published date: 01 February 2019

Received: 29 September 2016 Revised: 9 May2018 Accepted: 6 June 2018

DOI: 10.1111/faam.12183

REVIEW ARTICLE

Accounting research on health care – Trends and

gaps

Margit Malmmose

Departmentof Management, Aarhus University,

Fuglesangsalle 4, 8210, Aarhus V, Denmark

Correspondence

MargitMalmmose, Department of Management,

AarhusUniversity, Fuglesangs alle 4, 8210 Aarhus

V,Denmark.

Email:mmalmmose@mgmt.au.dk

Abstract

This study reviews 317 accounting studies in health care from the

past 40 years. In addition to a traditional description of the the-

ory 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 account-

ing 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 collec-

tion, which increases the possibility of representing individual stake-

holders. 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 Scandinaviancountries 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 natu-

ral developmentwith New Public Management (NPM) reform devel-

opments. 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 major-

ity 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.

KEYWORDS

accounting, health care reform, literature review, New Public Man-

agement

1INTRODUCTION

The purpose of this literature review is to identify the emerging accounting research agenda surrounding the devel-

opment of health care reforms during the past 40 years, with a specific emphasis on identifying represented countries,

90 c

2018 John Wiley & Sons Ltd wileyonlinelibrary.com/journal/faam FinancialAcc & Man. 2019;35:90–114.

MALMMOSE 91

incorporatedstakeholder perspectives, and developed longitudinal accounting focuses. The aim of this review is to illu-

minate particular trends and gaps in the health care accounting literatureto disseminate awareness of available future

research approaches.

The research area of accounting in health care is relevant for several reasons. First, according to the World Bank,

health care expenditures within the OECD countries are continuously on the rise, with a growth from 9.2% of GDP

in 1995 to 12.4% in 2014 (The World Bank, 2014). Thus, the health care sector comprises a dominant part of public

expenditures. The increasing health care costs combined with the 20th century's transnational trend of systemizing

the health care sector through public spending have also sparkedincreased and sustained governmental intervention

labelled New Public Management (NPM) (Hood, 2001; Malmmose, 2015)1. Second, the NPM reform wavehas particu-

larly stressed accounting elements of efficiency,cost control, budgeting, and performance measures (Gruening, 2001;

Hood, 2001; Lapsley & Wright, 2004). As a result, NPM has been applied as a proxy for optimizing the public sector

to continuously improve efficiency, which has been extensivelydiscussed in the accounting literature (Broadbent &

Guthrie, 2008; van Helden, 2005). Consequently,several public sector literature reviews have been conducted with a

specific focus on accounting research.

Public sector literature reviews encompass work completed by Broadbent and Guthrie (1992, 2008), which shows

that much research effort has been devoted to the area of NPM in health care. The 1992 study by Broadbent and

Guthrie focuses on a trend within accounting research that they designate “alternative” accounting research. They

argue that accounting affects social and organizational practices, which initiate these “alternative”studies. Based on

an extensiveliterature review published in 2008, Broadbent and Guthrie further concluded that management account-

ing is the most researched area within public services. Analogously,they find that health care is the most studied field

within the public sector. This justifies a specific accounting literaturereview on public health care. van Helden (2005)

conducteda study on the role of management accounting within the entire public sector. Similarly, Goddard (2001) con-

tributed a literature review of accounting in the public sector.However, both of these literature reviews span a short

period of time (3 years). In contrast, Jacobs (2012) conducted a longitudinal literaturereview from 1992 to 2008. This

study thoroughly identifies research theory application and development within public sector accounting research.

In contrast to the aforementioned studies, the present study focuses on accounting literatureavailable online, pub-

lished, English language only, from 1977 until 20162, and concentrating on the public health care sector3.Thisstudy

will include all accounting research but with a natural emphasis on some management accounting themes due to the

fact that the majority of the research identified is within the specific field of management accounting. Moreover,the

majority of NPM themes are identical to some of the most relevant management accounting tools such as costing, bud-

geting, and performance measures. However,accounting literature is reviewed in general in order to capture a broad

scope. While identifying the traditional descriptive data of journal, volume, theory,method, and country of study, this

study will further contribute with two particular themes. First, leaning on Fairclough's (2001) discursive depiction of

texts,the stakeholder perspectives applied in the study, typically through the represented data collection, will be iden-

tified. Second, the longitudinal trend of the topic of accounting highlighted in the literature is assessed and reflected

toward NPM reform development, leaning on Hood and Peters’ (1995) conceptualization of the NPM research field

and development.

In the remaining part of the introduction, it is necessary to address a classic concern of the US research agenda

to reflect on US research inclusion in this literature review. Moreover, the loosely applied theoretical framework will

be further elucidated to clarify the application of Fairclough's (2001) and Hood & Peters’ (1995) concepts. Following

this introduction, the research design and structure of analysis are explained. The Research Design section further

explicates the specific deployment of the conceptual frameworks of Fairclough (2001) and Hood and Peters (1995).

Next, the findings are presented. Finally,based on the findings, research trends and gaps are discussed.

1.1 Accentuation: global hybridization of NPM elements including the United States

Typically, NPM is viewed as originating in the UK and/or New Zealand (Boden, Gummett, Cox,& Barker, 1998; Hood,

2001; Lawrence, Alam, & Lowe, 1994; Whitcombe, 2008), and literature reviews on NPM often excludeUS literature