Responsibility accounting revived? Market reforms and budgetary control in health care

Abstract There have been numerous attempts to implement responsibility accounting systems within the National Health Service in the U.K. This paper traces these various attempts and shows that, for most of these initiatives, responsibility accounting systems did not function, as intended. The paper is informed by the institutional theorists perspective which demonstrates how responsibility accounting systems operated as myth—as a buffer or shield to legitimate the activities of the operational service to the major element of its external controlling environment, central government. However, market reforms in the U.K. have radically altered the mechanism for the coordination of health care delivery and appear to have established the antecedent conditions which will make responsibility accounting actionable and which may result in the accountants language and techniques dominating the organization of health care in a way has never proved possible, in the past.