From bookkeeping to strategic tools? A discussion of the reforms in the Nordic hospital sector

Abstract This paper presents some aspects on the introduction of more accountable management control reforms in the Nordic hospital sector. A contingency model is used to analyse the complexity of the public sector government. Contextual and behavioural variables are discussed to explain the reform processes in the Nordic countries. Several international field studies in the hospital settings show that there are similarities and differences in the implementation of the management reforms in the European countries. The most striking difference is the level of central state versus local government participation in the reform processes. In the Nordic countries, the reform initiative is centrally driven. But there are differences as to the use of national standard prices and pricing of services made by the hospitals themselves. Commercial-like management logic such as accrual accounting is gradually being introduced on a general level. However, there are different motives and directions of changes in the countries. The interpretation and use of accounting information by key clinicians needs careful evaluation. It is at this level of the individual clinical actors that the most important decisions are made about how resources are spent on hospital patient treatments.