IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v110y2013i2p156-163.html
   My bibliography  Save this article

Sources of financial pressure and up coding behavior in French public hospitals

Author

Listed:
  • Georgescu, Irène
  • Hartmann, Frank G.H.

Abstract

Drawing upon role theory and the literature concerning unintended consequences of financial pressure, this study investigates the effects of health care decision pressure from the hospital's administration and from the professional peer group on physician's inclination to engage in up coding. We explore two kinds of up coding, information-related and action-related, and develop hypothesis that connect these kinds of data manipulation to the sources of pressure via the intermediate effect of role conflict. Qualitative data from initial interviews with physicians and subsequent questionnaire evidence from 578 physicians in 14 French hospitals suggest that the source of pressure is a relevant predictor of physicians’ inclination to engage in data-manipulation. We further find that this effect is partly explained by the extent to which these pressures create role conflict. Given the concern about up coding in treatment-based reimbursement systems worldwide, our analysis adds to understanding how the design of the hospital's management control system may enhance this undesired type of behavior.

Suggested Citation

  • Georgescu, Irène & Hartmann, Frank G.H., 2013. "Sources of financial pressure and up coding behavior in French public hospitals," Health Policy, Elsevier, vol. 110(2), pages 156-163.
    • Handle: RePEc:eee:hepoli:v:110:y:2013:i:2:p:156-163
    DOI: 10.1016/j.healthpol.2013.02.003
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851013000432
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2013.02.003?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Berta, Paolo & Callea, Giuditta & Martini, Gianmaria & Vittadini, Giorgio, 2010. "The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: A population-based investigation," Economic Modelling, Elsevier, vol. 27(4), pages 812-821, July.
    2. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
    3. Hopwood, Ag, 1972. "Empirical Study Of Role Of Accounting Data In Performance Evaluation," Journal of Accounting Research, Wiley Blackwell, vol. 10, pages 156-182.
    4. William G. Ouchi, 1979. "A Conceptual Framework for the Design of Organizational Control Mechanisms," Management Science, INFORMS, vol. 25(9), pages 833-848, September.
    5. Hirst, Mk, 1983. "Reliance On Accounting Performance-Measures, Task Uncertainty, And Dysfunctional Behavior - Some Extensions," Journal of Accounting Research, Wiley Blackwell, vol. 21(2), pages 596-605.
    6. Abernethy, Margaret A. & Stoelwinder, Johannes U., 1995. "The role of professional control in the management of complex organizations," Accounting, Organizations and Society, Elsevier, vol. 20(1), pages 1-17, January.
    7. Steinbusch, Paul J.M. & Oostenbrink, Jan B. & Zuurbier, Joost J. & Schaepkens, Frans J.M., 2007. "The risk of upcoding in casemix systems: A comparative study," Health Policy, Elsevier, vol. 81(2-3), pages 289-299, May.
    8. Merchant, Kenneth A., 1990. "The effects of financial controls on data manipulation and management Myopia," Accounting, Organizations and Society, Elsevier, vol. 15(4), pages 297-313.
    9. Hopwood, Ag, 1972. "Empirical Study Of Role Of Accounting Data In Performance Evaluation - Reply," Journal of Accounting Research, Wiley Blackwell, vol. 10, pages 189-193.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Carine Milcent, 2021. "From downcoding to upcoding: DRG based payment in hospitals," International Journal of Health Economics and Management, Springer, vol. 21(1), pages 1-26, March.
    2. Laurent Mériade & Corinne Rochette, 2022. "Governance tensions in the healthcare sector: a contrasting case study in France," Post-Print hal-03516559, HAL.
    3. Carine Milcent, 2019. "From downcoding to upcoding: DRG based payment in hospitals," Working Papers halshs-02317416, HAL.
    4. Carine Milcent, 2019. "From downcoding to upcoding: DRG based payment in hospitals," PSE Working Papers halshs-02317416, HAL.
    5. Carine Milcent, 2019. "From downcoding to upcoding: DRG based payment in hospitals [Du downcoding au upcoding : Le paiement par DRG dans les hôpitaux]," PSE Working Papers halshs-03966671, HAL.
    6. Carine Milcent, 2016. "Upcoding and heterogeneity in hospitals’ response: A Natural Experiment," PSE Working Papers halshs-01340557, HAL.
    7. Carine Milcent, 2019. "From downcoding to upcoding: DRG based payment in hospitals [Du downcoding au upcoding : Le paiement par DRG dans les hôpitaux]," Working Papers halshs-03966671, HAL.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Irène Georgescu, 2012. "Communication de l'information et pressions financière interne: une étude exploratoire dans une organisation professionnelle," Post-Print hal-00690953, HAL.
    2. Chenhall, Robert H., 2003. "Management control systems design within its organizational context: findings from contingency-based research and directions for the future," Accounting, Organizations and Society, Elsevier, vol. 28(2-3), pages 127-168.
    3. Abernethy, Margaret A. & Brownell, Peter, 1997. "Management control systems in research and development organizations: The role of accounting, behavior and personnel controls," Accounting, Organizations and Society, Elsevier, vol. 22(3-4), pages 233-248.
    4. Hartmann, Frank G. H., 2000. "The appropriateness of RAPM: toward the further development of theory," Accounting, Organizations and Society, Elsevier, vol. 25(4-5), pages 451-482, May.
    5. Hartmann, Frank G. H. & Moers, Frank, 1999. "Testing contingency hypotheses in budgetary research: an evaluation of the use of moderated regression analysis," Accounting, Organizations and Society, Elsevier, vol. 24(4), pages 291-315, May.
    6. Parulian Silaen & Robert Williams, 2009. "Management control systems: a model for R&D units," Accounting Research Journal, Emerald Group Publishing Limited, vol. 22(3), pages 262-274, November.
    7. Granlund, Markus & Lukka, Kari, 2017. "Investigating highly established research paradigms: Reviving contextuality in contingency theory based management accounting research," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 45(C), pages 63-80.
    8. Matthias Mahlendorf, 2015. "Allowance for failure: reducing dysfunctional behavior by innovating accountability practices," Journal of Management & Governance, Springer;Accademia Italiana di Economia Aziendale (AIDEA), vol. 19(3), pages 655-686, August.
    9. Morgan, Neil A. & Clark, Bruce H. & Gooner, Rich, 2002. "Marketing productivity, marketing audits, and systems for marketing performance assessment: integrating multiple perspectives," Journal of Business Research, Elsevier, vol. 55(5), pages 363-375, May.
    10. Chong Lau & Christen Buckland, 2000. "Budget emphasis, participation, task difficulty and performance: the effect of diversity within culture," Accounting and Business Research, Taylor & Francis Journals, vol. 31(1), pages 37-55.
    11. Buczak-Stec, Elżbieta & Goryński, Paweł & Nitsch-Osuch, Aneta & Kanecki, Krzysztof & Tyszko, Piotr, 2017. "The impact of introducing a new hospital financing system (DRGs) in Poland on hospitalisations for atherosclerosis: An interrupted time series analysis (2004–2012)," Health Policy, Elsevier, vol. 121(11), pages 1186-1193.
    12. Marco Giovanni Rizzo, 2014. "La relazione tra il livello di coinvolgimento nel processo di budget, il commitment verso gli obiettivi, la soddisfazione lavorativa e i relativi risvolti sulla performance manageriale. I risultati di," MANAGEMENT CONTROL, FrancoAngeli Editore, vol. 2014(1), pages 9-34.
    13. Chenhall, Robert H. & Moers, Frank, 2015. "The role of innovation in the evolution of management accounting and its integration into management control," Accounting, Organizations and Society, Elsevier, vol. 47(C), pages 1-13.
    14. Bellora-Bienengräber, Lucia & Radtke, Robin R. & Widener, Sally K., 2022. "Counterproductive work behaviors and work climate: The role of an ethically focused management control system and peers’ self-focused behavior," Accounting, Organizations and Society, Elsevier, vol. 96(C).
    15. Marginson, David & Ogden, Stuart, 2005. "Coping with ambiguity through the budget: the positive effects of budgetary targets on managers' budgeting behaviours," Accounting, Organizations and Society, Elsevier, vol. 30(5), pages 435-456, July.
    16. Vagneur, K. & Peiperl, M., 2000. "Reconsidering performance evaluative style," Accounting, Organizations and Society, Elsevier, vol. 25(4-5), pages 511-525, May.
    17. Bedford, David S. & Speklé, Roland F. & Widener, Sally K., 2022. "Budgeting and employee stress in times of crisis: Evidence from the Covid-19 pandemic," Accounting, Organizations and Society, Elsevier, vol. 101(C).
    18. Stéphanie Chatelain-Ponroy, 2009. "Le recours à la métaphore : une voie de compréhension du contrôle de gestion dans les organisations non marchandes ?," Post-Print halshs-00393062, HAL.
    19. Ditillo, Angelo, 2004. "Dealing with uncertainty in knowledge-intensive firms: the role of management control systems as knowledge integration mechanisms," Accounting, Organizations and Society, Elsevier, vol. 29(3-4), pages 401-421.
    20. repec:dau:papers:123456789/1138 is not listed on IDEAS
    21. Sarah A. Hinchliffe, 2019. "A Focus on ‘Control’: Reconciling Contemporary Transaction Cost Economics with Behavioural Contingency Accounting Perspectives," Accounting and Finance Research, Sciedu Press, vol. 8(2), pages 189-189, May.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:110:y:2013:i:2:p:156-163. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.