Regulatory innovation and (de)legitimisation: accountability challenges in the healthcare field

Accounting research examines accountability in the healthcare field but little attention is paid to how contemporary regulatory innovations (e.g. AI-driven data algorithms) impact accountability objectives. We address this concern through a study of how regulatory innovations may appropriate accountability by (de)legitimising healthcare actions. This is examined in the case of a regulatory innovation enacted in the US healthcare sector. Specifically, we employ a field study of a healthcare provider subject to oversight to highlight how actors (de)legitimise the provision of healthcare services. Our findings show that regulatory innovation generates debates around illegitimate services as determined by healthcare oversight contractors. These contractors are incentivised to appropriate AI-driven data algorithms towards a focus on reducing costs of non-standard healthcare services while healthcare providers legitimate those services as quality healthcare. Additionally, findings suggest that more extensive implementation of AI-driven data algorithms in the healthcare field may serve to limit healthcare options, particularly when combined with private contracting. This study contributes to the literature by showing the (de)legitimising consequences that regulatory innovations combining the use of algorithmic decision-making and private incentive contracts have for accountability and delivery of services in the healthcare field.