Management accounting versus medical profession discourse: Hegemony in a public health care debate – A case from Denmark

This study uses discourse, ideology and hegemony as a theoretical foundation to investigate the development of the polarised discourses of management accounting and the medical profession during the introduction of a NPM reform in the public health care debate, using Denmark as a case study. 194 newspaper articles and 73 medical profession articles from 2002 to 2008 are analysed, using critical discourse analysis. The analysis shows that the management accounting discourse becomes the dominating ideology which is embedded in the public rhetorical debate. There are three peculiar outcomes of this domination; the absence of physicians in the general public debate, the creation of a phantom phenomenon meaning that the negative consequences of the reform are blamed on a third person, typically the system, and finally a changing meaning of the health care service quality provided from a medical perspective of a patient oriented focus to a quantitative focus through strong rationalised arguments. This puts the medical profession in a dilemma concerning their ideological Hippocratic Oath versus the NPM efficiency focus. However, they choose to gradually adopt management accounting terms in their own medical professional debate.