Getting management accounting off the ground: post-colonial neoliberalism in healthcare budgets

Abstract

Taking Modell's [(2014) The societal relevance of management accounting: an introduction to the special issue. Accounting and Business Research, 44 (2), 83–103] ‘societal relevance of management accounting’ agenda forward, and based on a cost accounting initiative in a Sri Lankan hospital, this paper examines how management accounting is implicated in societal relevance. It reports on a post-colonial neoliberal state's use of cost-saving experiments and the resultant emancipation of the individuals involved. It conducts a bottom-up analysis, from micro events in the hospital to policymaking at the level of the Provincial Council. This analysis suggests that cost accounting acts as a mediating instrument: it begins to loosen the old Keynesian post-colonial bureaucratic budget confinements, creates a social space for individuals to consider cost-saving experiments, and addresses wider policy concerns about hospital resource management. The story is illuminated by Gilles Deleuze's and Zigmund Bauman's ideas on post-panoptic societies: old confinements are being problematised and new flexible, ‘liquid’ spaces created, in which individuals are emancipated in terms of their ability to influence resource management within and beyond the organisational constituency.

Keywords:

• bureaucratic budgets
• healthcare reforms
• hospital cost accounting
• individualisation
• less-developed countries
• neoliberal state
• Sri Lanka

Acknowledgements

Special thanks are offered to Sven Modell, Vivien Beattie, Chandana Alawattage, Rafael Heinzelmann, and anonymous reviewers for their insightful and constructive comments and guidance. I gratefully acknowledge the support of all the respondents from the hospital, the Ministry of Health, and the political authorities consulted in Sri Lanka. Also, I would like to thank the participants in the paper's presentation at Norwegian School of Economics in October 2012 and at APIRA Conference held in Kobe, Japan in July 2013.

Disclosure statement

No potential conflict of interest was reported by the author.

Funding

The author would like to acknowledge the financial assistance of the universities of Hull and Glasgow.

Notes

1. For various new perspectives, a special issue of Accounting and Business Research (Vol. 44, Issue 2, 2014) is dedicated to this theme.

2. The notion of ‘public’ in ‘the public sector’ carries both a political connotation and a social connotation. For example, in the accounting literature, Burchell et al. (1980, p. 9) emphasise that ‘in a social context, public actions need to have either a political means for their enforcement or a wider social significance and legitimacy’.

3. The Manchester School of Social Anthropology first coined the phrase ECM (Garbett 1973). Burawoy (1998) revitalised the use of this approach, based on his decades of ethnographic studies in non-Western countries. The term implies a holistic approach to qualitative research in the social sciences.

4. PCs are a new form of political mechanism, introduced through the Provincial Council Act of 1987. In accordance with the terms and conditions of the Indo-Lanka Peace Accord, the aim of this Act was to devolve central government powers to the provinces. There are nine PCs. As a result of 30 years of civil war, however, there are no councils in, for example, the North and East provinces.

5. A small island (area 65,610 km²) in the Indian Ocean, Sri Lanka was a European colony for nearly 450 years from 1505 to 1948.

6. This initiative was intended to devolve the centralised political and decision-making powers to the country's six provinces. A PC is a regional body consisting of members elected every five years.