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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.

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.

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.

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.

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.

This study traces the development of financial reporting in two publicly funded hospitals in New South Wales over the period 1857 to post‐1975, with particular focus on the use of cash and accrual accounting. The historical analysis draws on process and contextual change and stakeholder theory, and uses both primary and secondary data, to describe patterns of change (and non‐change) in the hospitals’ financial reporting and to identify the social and political influences associated with such reporting. The study provides historical context for recent developments in public sector reporting and accountability in Australia, particularly the (re)introduction of accrual accounting, and provides insights into the nature of accounting change both in public sector organizations and generally.

The financing of healthcare services has been of a major concern to all governments in the face of increasing healthcare costs. For developing countries, where good health is considered a poverty reduction strategy, it is imperative that the hospitals used in the delivery of healthcare services are well financed to accomplish their tasks. The purpose of this paper is to examine how public hospitals in Ghana are financed, and the challenges facing the financing modes adopted.

To achieve the objectives of the study, one major public healthcare institution in Ghana became the main focus.

The findings of the study revealed that the main sources of financing the public healthcare institution are government subvention, internally‐generated funds and donor‐pooled funds. Of these sources, the internally generated fund was regarded as the most reliable, and the least reliable was the donor‐pooled funds. Several challenges associated with the various financing sources were identified. These include delay in receipt of government subvention, delay in the reimbursement of services provided to subscribers of health insurance schemes, influence of government in setting user fees, and the specifications to which donor funds are put.

The findings of this study have important implications for improving the financing of public healthcare institutions in Ghana. A number of recommendations are provided in this regard.

The purpose of this paper is to trace the changes in accounting practice in UK hospitals, focussing on costing, funding and budgetary control, and to place more recent accounting changes in their historic context.

The paper is largely chronological and draws from previous research by the author and other secondary sources, both of which are supplemented by reference to government publications, accounting practitioner journals and public records.

The paper argues that contrary to many implicit assumptions in academic accounting studies, our accounting ancestors promoted, and sometimes used, accounting data in pursuit of similar objectives to those advocated in the twenty‐first century. But, although cost information “evolved”, within its historical context, the process of establishing standard costs was slow and sometimes controversial, and the use of such information for funding hospital activity was avoided. In addition, the history of accounting reform in UK hospitals is one littered with disappointing results.

The paper provides an historical context to more recent accounting reforms in UK hospitals and suggests that the long history of “problems” documented in the paper may provide some cautionary counsel to contemporary accounting reformers.

The purpose of this paper is to explore how far plans to “modernize” hospital management in China are converging toward a global model of new public management (NPM) or represent a distinctive pathway.

This paper draws on a systematic review of available secondary sources published in English and Chinese to describe both the nature and trajectory of hospital management reforms in China.

In China, while public hospital reforms bear many of the hallmarks of the NPM, they are distinctive in two key respects. First, the thrust of current reforms is to partially reverse, not extend, the trend toward marketization in order to strengthen the public orientation of public hospitals. Second is a marked gap between the rhetoric and reality of empowering managers and freeing them from political control.

This paper develops a framework for understanding the drivers and obstacles to hospital management reforms in China that is useful for managers, clinicians and policy makers.

In China, few authors have considered NPM reform in relation to healthcare. This paper contributes in better understanding current reforms taking place in China’s expanding healthcare sector and locates these within broader theoretical and policy debates.

The purpose of this paper is to present the findings of a small-scale evaluation of the Department of Health “Homeless Hospital Discharge Fund” (HHDF) in England.

The paper is based on a mixed-method approach comprising 52 telephone interviews with project staff, 48 responses from an online survey with staff, outcomes data collected by projects, 30 semi-structured interviews with patients and nine in-depth telephone interviews with staff and commissioners.

Overall the 52 pilots funded under the “HHDF” provided positive health and accommodation outcomes for homeless people admitted and discharged from hospital. In contrast to previous studies patients described not feeling judged during their stay, however the admission process was a more mixed experience due to communication breakdown by hospital staff. Integrating housing and clinical staff in the hospital discharge projects produced better outcomes for patients and the availability of accommodation as part of the model allowed improved and more stable housing outcomes. We recommend integrated commissioning takes place for future funding of any hospital discharge projects.

The study was small in scale and carried out before some of the projects had become fully established. The data were self-reported and the quality and completeness varied between projects.

This is one of the few examples of hospital discharge outcomes for homeless people across a number of different localities and project models which examine the role of both health and housing professionals in the process.

This paper examines how “quality” was framed in the design and implementation of a policy to reform hospital funding and associated care delivery. The aims of the study were: (1) To describe how government policy-makers who designed the policy and managers and clinicians who implemented the policy framed the concept of “quality” and (2) To explore how frames of quality and the framing process may have influenced policy implementation.

The authors conducted a secondary analysis of data from a qualitative case study involving semi-structured interviews with 45 purposefully selected key informants involved in the design and implementation of the quality-based procedures policy in Ontario, Canada. The authors used framing theory to inform coding and analysis.

The authors found that policy designers perpetuated a broader frame of quality than implementers who held more narrow frames of quality. Frame divergence was further characterized by how informants framed the relationship between clinical and financial domains of quality. Several environmental and organizational factors influenced how quality was framed by implementers.

As health systems around the world increasingly implement new models of governance and financing to strengthen quality of care, there is a need to consider how “quality” is framed in the context of these policies and with what effect. This is the first framing analysis of “quality” in health policy.

Purpose: In this chapter, we examine the National Health Service (NHS) and Adult Social Care (ASC) in England, focussing on policies that have been introduced since 2000 and considering the challenges that providers face in their quest to provide a high standard and affordable health service in the near future.

Methodology/Approach: We discuss recent policy developments and published analysis covering innovations within major aspects of health care (primary, secondary and tertiary) and ASC, before considering future challenges faced by providers in England, highlighted by a 2017 UK Parliament Select Committee.

Findings: The NHS and ASC system have experienced tightening budgets and serious financial pressure, with historically low real-terms growth in health funding from central government and local authorities. Policymakers have tried to overcome these challenges with several policy innovations, but many still remain. With large-scale investment and reform, there is potential for the health and social care system to evolve into a modern service capable of dealing with the needs of an ageing population. However, if these challenges are not met, then it is set to continue struggling with a lack of appropriate facilities, an overstretched staff and a system not entirely appropriate for its patients.

This paper focuses on the impact of recent federal health policy on local community efforts to support the survival of rural hospitals. Rural communities in the United States have an established tradition of providing public financial support to local hospitals. The Balanced Budget Act of 1997 (BBA) expanded Medicare’s prospective payment system to non-acute care services, which promised reduced hospital reimbursement. Part of this legislation, the Critical Access Hospital (CAH) program, was specifically designed to counter the negative impact the broader legislation was expected to have. This study was designed to investigate the hypothesis that counties receiving financial relief for local hospitals through participation in the CAH program would show decreases in county subsidy levels compared to other hospitals. All 123 hospitals in Kansas were studied in 1994, well before BBA legislation, and again in 2001. Data on county-level health care spending for each of the two years were abstracted from all county budgets in Kansas. The amounts counties contributed to local hospitals were calculated and compared in terms of CAH versus non-CAH hospitals with attention to patterns of increase. Results showed that CAH hospitals, in spite of participation in the federal program, received greater local public financial support and experienced greater funding increases than other community hospitals. The implications of these findings are discussed in terms of the circumstances of rural hospitals and recent changes in the CAH program.

The NHS review has implications for the funding of teaching hospitals and the relationship between them and the medical schools. The ring‐fencing of the Service Increment for Teaching and Research (SIFTR) and the need to develop contractual relationships for the provision of service facilities for teaching and research means that more information is needed on the nature and distribution of the service costs of these activities. The article describes research which informed the process of allocating SIFTR in a large teaching district. A methodology for developing rational SIFTR contracts is described and the implications for the future of medical education and research discussed. The local distribution of SIFTR must be well managed if teaching and research are not to suffer as a result of the financial pressures generated by the NHS review.