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Concern over the rising cost of medical care has caused many countries to investigate and implement different methods of cost containment, particularly for hospital services. In the United States, Medicare replaced its ‘cost‐based’ reimbursement system, in which hospital payments were based on the actual costs incurred in treating patients, with a system that pays hospitals a fixed price per case. Under this new system, all hospital discharges are classified into 467 Diagnosis Related Groups (DRGs) or types of cases based on the patient's age, sex, principal diagnosis, additional diagnoses (comorbidities and complications), surgical procedures performed, and the discharge status. During the first three years of the programme, the payment rate for each DRG is a function of a DRG weight (reflecting relative resource consumption), the hospital's historic costs of treating patients in that DRG, and a federally established rate adjusted for urban/rural differences and census region. In the fourth year the price will be based only on the DRG weight and the federally established rate.

In October 1983, a new hospital payment system was introduced in the United States which was a radical departure from traditional methods of reimbursement. Concern over continuing increases in expenditures for hospital care caused Medicare to replace its ‘cost based’ reimbursement system, in which hospital payments were based on the actual costs incurred in treating patients, with a system that pays hospitals a fixed price per case. If a patient's treatment plan costs less than the fixed rate, the hospital may keep the difference; but if its costs in providing services exceed the rate, the hospital must absorb the loss.

Whereas many researchers have examined the way in which health institutions have been transformed through funding modalities, and particularly through prospective payment systems (PPS), few have investigated the architecture of these systems, that is, costs and cost variance. Focusing on the study of costs and on the production of hospital rates, this chapter shows that the French PPS, called “rate per activity” made possible what we call a policy of variance. For health policymakers, the aim was to make the different accounting figures between hospitals, and between ways of practising healthcare, visible, in order to reduce these variances. This policy was attended by uncertainty in the processes of quantification, which led to metrological controversies. As a consequence of the issues around the way of calculating costs, some accounts and calculations were redone. In this chapter, we consider the case of metrological controversy over the remuneration of costs for cystic fibrosis patients’ hospital stays, and over the action of a patient organization that criticized the costs calculated officially. It leads to the analysis of the way calculative infrastructures, as cost accounting and rates, are challenged, and how some actors try to stabilize them.

As an American participant in ‘Management and Financing of Hospital Services’, the DRG Convention held in London on llth‐13th December, 1986, I had looked forward to the presentations with a great deal of happy anticipation. That may seem a strange attitude unless one recognises that the life of a ‘DRG expert’ in the USA today is not necessarily a happy one. Like it or not, we are viewed as policemen. Much of the continuous, carping and often self‐serving criticism levelled against us can be described as woeful pleas from a band of corsairs; not very bloodthirsty ones mind you, but rapacious nonetheless.

In calculations of inventory control costs, the effects of stockouts are often assumed or avoided because of the lack of accounting data for reasonable measurements. The authors describe the development of stockout cost models incorporating decisions made by consumers in an actual retail situation. Equations for calculating the revenue differences are based on the consumer decision alternatives. The results of a consumer survey, combined with retail prices for the product lines in question, enable the financial effects of stockouts to be calculated.

This research paper delineates and analyzes the relationship between production and operations management and the development of society. An attempt is made to take the reader into a historical journey whereby events and contributions to the field are not only listed and described but also analyzed with regard to their impact on societal development through time.

Robert Franklin Hoxie was of the first generation of University of Chicago economists, a figure of significance in his own time. He is often heralded as the first of the Institutional economists and the impetus behind the field of labor economics. Yet today, his contributions appear as mere footnotes in the history of economic thought, when mentioned at all, despite the fact that in his professional and popular writings he tackled some of the most pressing problems of the day. The topics upon which he focused included bimetallism, price theory, methodology, the economics profession, socialism, syndicalism, scientific management, and trade unionism, the last being the field with which he is most closely associated. His work attracted the notice of some of the most famous economists of his time, including Frank Fetter, J. Laurence Laughlin, Thorstein Veblen, and John R. Commons. For all the promise, his suicide at the age of 48 ended what could have been a storied career. This paper is an attempt to resurrect Hoxie through a review of his life and work, placing him within the social and intellectual milieux of his time.