University of Oulu

Vesty, G., Kokshagina, O., Jansson, M., Cheong, F. and Butler-Henderson, K. (2022), "Accounting, valuing and investing in health care: dealing with outdated accounting models", Meditari Accountancy Research, Vol. ahead-of-print No. ahead-of-print.

Accounting, valuing and investing in health care : dealing with outdated accounting models

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Author: Vesty, Gillian1; Kokshagina, Olga2; Jansson, Miia3;
Organizations: 1School of Accounting, Information Systems and Supply Chain, RMIT, Melbourne, Australia
2Graduate School of Business and Law, RMIT University, Melbourne, Australia
3Research Unit of Medical Imaging, Physics and Technology, Oulu University, Oulu, Finland
4School of Accounting, Information Systems and Supply Chain, RMIT University, Melbourne, Australia
5School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
Persistent link:
Language: English
Published: Emerald, 2022
Publish Date: 2022-06-09


Purpose: Despite major progress made in improving the health and well-being of millions of people, more efforts are needed for investment in 21st century health care. However, public hospital waiting lists continue to grow. At the same time, there has been increased investment in e-health and digital interventions to enhance population health and reduce hospital admissions. The purpose of this study is to highlight the accounting challenges associated with measuring, investing and accounting for value in this setting. The authors argue that this requires more nuanced performance metrics that effect a shift from a technical practice to one that embraces social and moral values.

Design/methodology/approach: This research is based on field interviews held with clinicians, accountants and administrators in public hospitals throughout Australia and Europe. The field research and multidisciplinary narratives offer insights and issues relating to value and valuing and managing digital health investment decisions for the post-COVID-19 “value-based health-care” future of accounting in the hospital setting.

Findings: The authors find that the complex activity-based hospital funding models operate as a black box, with limited clinician understanding and hybridised accounting expertise for informed social, moral and ethical decision-making. While there is malleability of the health economics-derived activity-based hospital funding models, value contestation and conflict are evident in the operationalisation of these models in practice. Activity-based funding (ABF) mechanisms reward patient throughput volumes in hospitals but at the same time stymie investment in digital health. Although classified as strategic investments, there is a limit to strategic planning.

Research limitations/implications: Accounting in public hospitals has become increasingly visible and contested during the pandemic-driven health-care crisis. Further research is required to examine the hybridising accounting expertise as it is increasingly implicated in the incremental changes to ABF in the emergence of value-based health care and associated digital health investment strategies. Despite operationalising these health economic models in practice, accountants are currently being blamed for dysfunctional health-care decisions. Further education for practicing accountants is required to effect operational change. This includes education on the significant moral and ethical dilemmas that result from accounting for patient mix choices in public hospital service provision.

Originality/value: This research involved a multidisciplinary team from accounting, digital health, information systems, value-based health care and clinical expertise. Unique insights on the move to digital health care are provided. This study contributes to policy development and the limited value-based health-care literature in accounting.

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Series: Meditari accountancy research
ISSN: 2049-372X
ISSN-E: 2049-3738
ISSN-L: 2049-372X
Volume: In press
DOI: 10.1108/MEDAR-06-2021-1334
Type of Publication: A1 Journal article – refereed
Field of Science: 217 Medical engineering
Funding: Funding: Institute of Management Accountants, Academic Research Grant Program.
Copyright information: © 2022, Emerald Publishing Limited. The final authenticated version is available online at