Determinants of changes in accounting practices: Accounting and the UK Health Service

This paper uses the Social Forces Model to investigate the interplay between accounting change, institutional evolution and organizational transformations in UK healthcare delivery since 1800. At the same time, the catalytic role of individuals and events is highlighted. The reflexive organizational-accounting interactions are charted to reveal the changing nature of healthcare provision from communitarianism, through etatism to the (etatist inspired) market-based structure which, in turn, is now giving way to service provision based on local planning. By using a long time span it is possible to identify the modes of accounting which were present during the different phases of the development of healthcare. This analysis contributes to our understanding of the historical interplay of social forces by showing accounting as a technical instrument within an institutional setting, by highlighting the interactive nature of accounting and institutional change, by illuminating the role of individual action and by identifying the role of outside agencies.