In the last few years, the public sector worldwide has been subjected to several waves of reform, which have also affected relations across tiers of government.
NPM-inspired reforms have generally promoted decentralisation processes whereby lower tiers of government have increased their autonomy, ideally in exchange for greater accountability. More recently, however, many countries have been experiencing a recentralisation of their public sectors, largely as a reaction of the financial crisis on the one hand, a growing disillusionment about the performance and accountability of the devolved organisations on the other.
This paper uses Miller & Power’s (2013) taxonomy of the roles of accounting (territorializing, mediating, adjudicating, and subjectivizing) to investigate whether and how accounting has been used to support, resist, or otherwise affect recentralisation. The empirical setting is provided by the Italian National Health Service (INHS). In the 1990s, the INHS was the component of the Italian public sector that most extensively espoused managerialism and decentralisation: jurisdiction over health care was devolved to the country’s 21 Regions; public health-care organisations were given significant autonomy and encouraged to adopt managerial logics and techniques. At least in some Regions, however, this produced large deficits and inadequate levels of care. Starting around 2005, therefore, the central government has intensified its monitoring of the Regions. To this end, however, a key prerequisite was a reform of the accounting rules to generate more reliable and comparable data about the Regions’ and the health care organisations’ financial positions and performances. Such reform was passed in 2011. More recently, the central government also introduced an algorithm that, for control and evaluation purposes, recalculates the revenues of health-care organisations to better reflect the quantity and mix of services provided.
The paper combines an extensive documentary analysis with interviews with several key players at the national and regional levels.
Preliminary results show that, to some extent, the 2011 accounting reform was intended to provide a better representation of the Regions’ and individual health care organisations’ financial positions and performances. There are, however, clear instances where accounting rules were introduced to impose specific behaviours on the Regions and health-care organisations; where the Regions and health-care organisations tried to reinterpret or circumvent such rules in order to resist these impositions; where the rules were jointly rewritten or reinterpreted by the central government and the Regions to achieve an acceptable compromise; where the emphasis in legislation shifted from the financial statements of individual health-care organisations to the region-wide consolidated statements, and then at least partially back from the latter to the former, as the central government attempted first to reinforce its oversight on the Regions and then to extend it to individual health-care organisations.
These results thus confirm that accounting was deliberately used to support the recentralisation process. They also shed some light on how the four roles of accounting interact (e.g. coexist, support, mutually exclude one another) in the context of changing relations across tiers of government.
Accounting and accountability of value creation in innovative public service delivery arra
