Accounting artifacts and the reformation of a national healthcare system

This study examines the role of ‘accounting artifacts’ in the reformation of a country’s healthcare system. Focusing on a single hospital and four decades of policy reform in the African nation of Ghana, and starting from Pierre Bourdieu’s Logic of Practice, the study shows how different forms, constructions, and classifications of accounting information—or accounting artifacts—shape policy regimes and facilitate particular patterns of activity and interaction. The study demonstrates how these regimes and patterns, in conjunction with the embedded social memory or habitus of individual actors, in turn lead to the construction and use of new artifacts. Finally, the study highlights how hospital staff and patients use various tactics to work with and around these artifacts, resulting in at times unintended consequences and the need to pursue new policy directions. In so doing, the study furthers our understanding of why policy-reform processes in the field of healthcare are so often sequential, if not perpetual, in nature.