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This study evaluates whether sociodemographic characteristics, political affiliation, family-related circumstances, self-reported health status, and access to health insurance affect public opinion toward the current US health-care system. Opinions about the health-care system were measured in terms of consumer confidence and perceived need for health-care reform. Data come from the 2008 Cooperative Congressional Election Study (CCES), a nationwide survey of 1,000 respondents. All data were collected in November 2008, thus providing a useful alternative to volatile polling data because they were collected prior to and are thus immune to the polarized tone of the debates that have occurred over the past few years. Overall, we found that public confidence in medical technology and quality of care were consistently high, while confidence in the affordability of medical care was much lower among respondents. Younger adults, those with poor health, and those without health insurance had particularly low confidence in their ability to pay for health care. Although a strong majority of the population agreed that the US health-care system was in need of major reform, support for particular types of government-sponsored health insurance programs was primarily determined by political affiliation. In an era where a large proportion of the population has little access to health care (due to lack of insurance) and where the US government is facing tremendous opposition to the implementation of major reform efforts, it is useful to understand which subgroups of the population are most confident in the current health-care system and most likely to support reform efforts, as well as those who are most resistant to change given their precarious health needs, their inability to access health care (as a result of insurance or noninsurance), or their political affiliation.

Thailand continuously has had administrative reforms in spite of periods of military regime and democratic government. This chapter describes the leadership of administration reforms coming from issue experts and senior civil service officers described as a ‘jazz-banded’ leadership model of different actors. Political parties pick up reform packages consistent with their policy platforms, while the military looks for ready-to-deliver policy packages. The author discusses the example of education and health care reforms and the role of the Office of Public Sector Development Commission (OPDC). In Thailand, resistance usually occurred during the implantation stage rather than at the formulation stage. The chapter discusses that OPDC initiatives were implemented with bonuses of up to 12-month salary for some senior officers and department heads. In health care, success came from concerted efforts of health care experts who transcend their ideas from one generation to another and who kept convincing politicians running the Ministry of Public Health. However, in other instances, budget allocations may bump up against financial procedures that are detailed and tight due to anti-corruption practices. In education reforms, teachers were placed at different school districts that lacked commitment. In the decentralization of reforms, resistance comes from line ministries wanting to secure their authority, although local authorities are very active. Resistance often requires negotiation of many parties; rarely do politicians step in to overcome and assist.

Purpose – The paper aims at understanding the potential role of management accounting during a public hospital organisational change within a developing country in transition, Egypt. Design/methodology/approach – The paper is based on in‐depth interviews, an analysis of documents, and direct observations. It uses a framework informed by institutional theory together with Giddens' (1990) notion of ‘elements of system contradiction’ to analyse the empirical findings. The paper draws on both DiMaggio and Powell's (1983) notion of coercive, mimic and normative isomorphic mechanisms to link a changing hospital to the changes in the wider social and institutional context wherein public hospitals operate, while exploring the interlinkages between these changes and the hospital's processes of accounting change and institutionalisation (Burns and Scapens, 2000); and Giddens' (1990) notion of ‘elements of system contradiction’ in order to evaluate the role of management accounting. Findings – The paper concludes that both the institutional change and reform around management accounting together with the changes in accounting systems are entrepreneurial processes in order to trigger a public hospital to change. Research limitations/implications – Although the empirical findings suggest resistance to management accounting change within the case study, a full investigation and explanation of such a resistance is an area of future research. Originality/value – In contrast to the technical role of accounting, the paper shows how management accounting is acted upon to disrupt the hospital's micro institutions and routines, challenge physicians' professional and bureaucratic power and therefore engendering the public hospital to change.

Purpose – The major question posed in this paper is whether public finance management (PFM) reforms undertaken by development partners (DPs) and the Ministry of Health (MOH) in Ghana were to find solutions to the many PFM challenges or it was merely a façade to pursue latent political interest?

Methodology – Study information was gathered via a desk review of major PFM policy documents, procedures, manuals, guidelines, and findings of commissioned studies covering the period under review. Information generated from the desk review was triangulated via extensive interviews with a sample of policy makers from MOH and DPs.

Findings – The findings suggest that MOH and DPs pursued reforms mostly to address the PFM challenges in the sector. Additionally, the study finds questionable the attitude and posture of the two actors and calls for further investigations to unearth what the said attitude and posture may imply in terms of intentions.

Originality/value – The findings raises fundamental question regarding public sector – DPs collaborations in executing reforms. This could open up new frontiers for further research to better understand DPs/public sector collaboration in the implementation of reforms.

Limitations – The sample used for this study may constrain generalization to other jurisdiction. This limitation does not in any case invalidate the conclusions arrived at.

The implications of new public management (NPM) have been studied from several theoretical perspectives. The present paper sets out to argue that there is a missing dimension to the theoretical debate regarding NPM reform – that of time and space. On the basis of two different notions of time‐space logics, the present paper seeks to develop a framework that contributes to a fuller understanding of NPM reform and organizational change/inertia in general.

The theoretical framework of the paper draws on studies of time and space in organizations, research on public‐sector reform, and neo‐institutional theory. The empirical case study presented here focuses on an attempt to change geriatric care using NPM initiatives.

The paper describes two paradigms of time‐space logics – the paradigm of “speed” (as used in finance and manufacturing) and the paradigm of “closeness” (as used in health care and associated care‐giving practices). The study argues that speed is a feature of almost all NPM programs, but that NPM programs are often directed at practices institutionalized by a time‐space paradigm of closeness. The study utilizes the two time‐space paradigms to understand the effects of NPM in the case reported. The use of time‐space paradigms in studies of public‐sector reform adds to the arsenal of theoretical tools for the analysis of NPM‐reform.

Although the methodology of a case study is an appropriate vehicle for introducing the time‐space paradigm to this area of research, the methodology is not well suited to generalizing the findings to other contexts. Future research could elaborate on the present study by applying quantitative approaches to the subject‐matter.

The study presents an analysis of an NPM‐reform program in geriatric care – a context in which ideas of “speed” clash with the traditional practice of “closeness”. This potential clash has important practical implications for managers.

The paper introduces notions of time and space into research on NPM‐reform. This novel approach to the study of NPM reform might be of value in future research.

Examines the move towards a commercialized, economically driven, health sector in New Zealand. Reforms involve extensive organizational rearrangements and the creation of profit‐driven businesses in place of public hospitals. These institutional rearrangements involve the fabrication of new ways of accounting. Attempts to understand the processes involved in the development of information technologies before they become accepted “facts” of organizational life. The fabrication of new technologies cannot be understood as an autonomous sphere of activity, but has to be understood as part of a complex series of political, economic and organizational contexts. Accountants are viewed not as mere technicians reporting on what is, but as active agents contributing to change. Accounting often acts as an arbiter in social conflict. Nowhere is this more evident than in the way it is being called upon to assist in the implementation of clause 25 of the Health and Disability Services Bill, which requires hospitals in New Zealand to act as competitive profit motivated commercial enterprises while at the same time meeting unspecified social obligations. The creation of a pseudo‐market for health services presents a challenge not only for accountants, but for all New Zealand citizens. The outcomes of the radical reforms are uncertain and some fear that the massive restructuring is in the form of an experiment. It is based on an ideology lacking empirical support. In the end it may be shown to have been impractical in the New Zealand context.

The purpose of this paper is to examine adoption of the balanced scorecard (BSC) by a large public-sector health organisation in an African country, Ethiopia as part of a programme to implement a unified sector-wide strategic planning and performance monitoring system. The study explains how this trans-organisational role of the BSC is constituted, and explores how it operates in practice at the sector-and organisation-levels.

The study employs the case-study method. Semi-structured interview data and documentary evidence are analysed by drawing on the concept of translation from actor-network theory.

The case-study organisation adopted the BSC as a part of broader public-sector reforms driven by political ideology. Through a centralised government decision, the BSC was framed as a sector-wide system aimed at: aligning the health sector’s strategic policy goals with strategic priorities and operational objectives of organisations in the sector; and unifying performance-monitoring of the sector’s organisations by enabling aggregation of performance information to a sector level in a timely manner to facilitate health sector policy implementation. While the political ideology facilitated BSC adoption for trans-organisational use, it provided little organisational discretion to integrate financial administration and human resource management practices to the BSC framework. Further, inadequate piloting of information system use for the anticipated BSC model, originating from the top-down approach followed in the BSC implementation, inhibited implementation of the BSC with a balanced emphasis between the planning and performance monitoring roles of the BSC. As a result, the BSC underwent a pragmatic shift in emphasis and was reconceptualised as a system of enhancing strategic alignment through integrated planning, compared to the balanced emphasis between the planning and performance monitoring roles initially anticipated.

The study provides a theory-based explanation of how politico-ideological contexts might facilitate the framing of novel roles for the BSC and how the roles translate into practice.

Public hospitals in China usually rely on revenues from medical services and medications to compensate for major costs given their nonprofit nature. The lack of government subsidies and unreasonable prices of medical services have led to high medical costs and unbalanced reimbursement system for public hospitals. There is a critical need of research on improvement of reimbursement system that will create positive effect on China’s health-care system. This paper aims to focus on four dimensions of stakeholders (government, patients, medical insurance agencies and social organization) and six major expenditures to explore reimbursement scheme for public hospitals in China with the purpose of relieving unbalanced income and expenditure of hospitals, avoiding medication markups and reducing medical expenses from patients.

In this paper, the authors study reimbursement scheme for public hospitals from the perspective of four dimensions of stakeholders and how stakeholders reimburse six major expenditures of hospitals. A total of 128 effective samples were collected from financial data of 32 public hospitals through 2009-2012. This paper analyzes the econometric models of the selected revenue and expenditure. This paper analyzes the econometric models of the selected revenue and expenditure using linear regression. The linear relationship between each cost and different types of incomes (i.e. reimbursements from government, patients, insurance agencies and social organization) is analyzed before and after cancelling the medication markups.

Results from empirical research verify that government reimbursement is insufficient, and using medication markups to compensate for medical service costs has become a serious problem for China’s public hospitals. To avoid the medication markups and improve the reimbursement scheme, government should reimburse labor cost, fixed assets cost and research cost; patients and medical insurance agencies should reimburse the costs of medical service, medication and administration/operations; and social organization should supplement the fixed assets cost.

In this study, the authors defined and classified stakeholders of reimbursement scheme for public hospitals in China, which help understand the roles and effects that different stakeholders can play in compensation. Along with the proposed reimbursement scheme framework, this study will help make effective implementation of new health-care reform program in China.

The purpose of this paper is to examine the implications for drug and alcohol treatment of radical policy changes being implemented by the government, particularly the proposed transition of responsibility for treatment from the National Treatment Agency to a new public health service from 2013.

It is argued that this is a critical moment in the development of substance misuse services in England, particularly given the impact of health service reform. Concerns are raised about the lack of reference to drug and alcohol treatment in key policy documents, such as the Department of Health's White Paper Healthy Lives, Healthy People. The removal of the “ring fence” from the pooled treatment budget may result in national disinvestment at a time when public spending cuts are likely to reduce local authority spending on drug and alcohol treatment. It will be challenging to deliver on the vision of recovery in the “Drug strategy 2010”.

The new public health structures and the commitment to recovery create new opportunities to improve services too – for example, the potential for joint working through Health and Wellbeing Boards. It is also positive that Healthy Lives, Healthy People stated that the NHS Constitution will apply to the public health service.

While these changes could provide a platform for improving outcomes, there is a genuine risk that substantial disinvestment in drug and alcohol services will be witnessed.