Harmonization of management accounting in health care

Purpose - – The purpose of this paper is to describe the standardization of cost accounting by diagnosis-related groups (DRG) and how specialized medical care has managed this change in Finland. Design/methodology/approach - – Qualitative research material was collected over six years to analyze the changes in the standardization process. Findings - – It was found that individual actors customize the process to meet their needs. Because the goal of standardization is comparison, the customization does not result in a homogenous national system. Research limitations/implications - – This paper’s limitation is that it focusses on an investigation of the adoption and use of the DRG system in hospital districts. Extending the research from this area to also cover health centres and regional hospitals could provide a broader picture of the use of the system. Practical implications - – Even though the actors report that they are using the DRG, our research illustrates how the same system is used in different ways and for different purposes in different organizations that impacts the original goal of national cost comparability. Originality/value - – This paper’s contribution is to show how the construction of an accounting system takes shape when spreading through organizations and society, and how its homogeneous nature is managed.