Case-mix accounting beyond the hospital

Purpose - This paper aims to examine how the customer can be better integrated into case-mix systems for primary healthcare. Case-mix is an established performance management tool in hospitals, and there is growing interest in its extensions into out-of-hospital healthcare. Design/methodology/approach - Interviews with academics and clinicians are used to explore conceptual foundations for this area. A service-dominant logic perspective is used to problematize the roles of accounting in this complex setting. Findings - The findings identify that a customer focus is embedded in current primary healthcare thinking, contrasting with the goods-dominant focus in hospitals. This paper identifies diverse objectives and coordinating networks of care as challenges for case-mix. Research limitations/implications - This paper breaks down the complexity of primary healthcare case-mix into two accounting roles: a “dialogue machine” to understand client objectives and a “learning machine” to understand clients’ networks of resources. The infancy of case-mix for primary healthcare means our interview sample is restricted to a small group of pioneers in the area, within a supply perspective. Practical implications - Primary healthcare management is a priority area in New Zealand. The findings describe opportunities and challenges for the “dialogue” and “learning” roles of accounting. This paper discusses practical and ideological tensions to be resolved when integrating customers into case-mix systems. Originality/value - This paper contributes to the limited literature on the use of case-mix accounting outside of hospitals, discussing the role of customers and networks of care. Findings contribute by describing the customer as both a source of, and a means to resolving, complexity.