British Accounting Review Special Issue: Performance Measurement, Sustainability and Governance in the Healthcare Sector

May 31, 2023
May 31, 2023

Interdisciplinary accounting research in topics related to performance measurement, sustainability and governance in healthcare organizations in general, and in light of the COVID-19 pandemic in particular, remains scarce. Pre-pandemic accounting research has explored the role of accounting in financial crises (e.g., Bracci et al., 2015) and natural disasters (e.g., Sargiacomo, 2014; Sargiacomo et al., 2021), while recent studies emphasize how accounting is implicated in the management of the COVID-19 pandemic in institutional settings such as Governments, municipalities, non-governmental organizations (NGOs) and museums (Agostino et al., 2020; Leoni et al., 2021; 2022), yet a surprising paucity of accounting research in healthcare settings remains (e.g., Huber et al., 2021). The COVID-19 pandemic has further emphasized the importance of investigating performance measurement, sustainability and governance issues in healthcare organizations. In fact, this sector has taken on a “new” centrality following the pandemic’s onset, showing more than ever its importance for health, its weaknesses in a fast and interconnected world, the need to accelerate its attention to the digital world, and the need for governance that goes beyond the single organization.

Guest Editors:

Salma Ibrahim, Kingston University, UK,
Christos Begkos, University of Manchester, UK,
Michela Arnaboldi, Politecnico di Milano, Italy,
Cameron Graham, York University, Canada,

Rationale and Scope:

The COVID-19 pandemic has highlighted international differences in the performance, sustainability and governance of healthcare organizations. Specifically, the additional cost of the pandemic on the healthcare system, in the form of screening, diagnosis and case management, has been substantial both in advanced and low-income economies, but to different degrees (Kaye et al., 2021; Torres-Rueda et al, 2021). In addition, sustainability in terms of reduced bed capacity, insufficient testing systems and equitable access to vaccines across different countries have been of the utmost concern (Macassa & Tomaselli, 2020; Eccleston-Turner & Upton, 2021).

Prior literature on performance measurement in healthcare settings tends to discuss multiple dimensions of hospital or healthcare organization performance such as efficiency, effectiveness and flexibility (e.g., Purbey et al., 2007). One important aspect within this broad topic focuses on costing and hospital reimbursement. Although healthcare systems around the world are inherently different, certain similarities exist. For example, the English National Health Service (NHS) employs Healthcare Resource Groups[1] (HRGs) to set reimbursement tariffs, thus displaying similar characteristics with funding systems that are based on Diagnosis Related Groups (DRGs), such as France, Germany, Austria, Sweden, Finland, Portugal, Italy, Australia and New Zealand (e.g., Busse et al., 2013). Pre-pandemic studies suggest that such cost-based funding systems benefit standardized treatments, disadvantage complex and emergency care, truncate management control and incentivize privatized care (Chapman et al., 2014; Llewellyn et al., 2020). Such implications may constitute cost-based funding systems untenable in light of national care crises. Thus, the investigation of performance measurement and costing practices in post-pandemic healthcare settings is important to shed light on how to reimburse complex, emergency care more accurately and fairly.

Another commonly investigated angle in prior research around performance measurement is financial reporting, with a focus on incentives that drive alternative forms of reporting. However, the findings are mixed and the evidence scarce. Some studies find that hospitals want to avoid reporting losses or excessive profits to appease their stakeholders (e.g., Leone and Van Horn, 2005; Eldenburg et al., 2011). Other findings suggest managers wish to report a smooth stream of profits to avoid scrutiny by the government, to avoid manager turnover and to reduce the cost of debt if the hospital relies on loans (Boterenbrood, 2014). Therefore, there is a need to advance knowledge in this area, to understand the incentives that drive financial reporting and operating decisions within the healthcare sector.

Research on sustainability and governance in healthcare organizations, while linked to the above-mentioned streams of research is separately investigated in terms of long-term financial performance. However, studies tend to be limited to non-business journals and therefore focus on medical issues (e.g., Lydon et al., 2008; Lu and Cohen, 2015) or contain limited discussions of accounting issues (e.g., Kruse and Jeurissen, 2020; Mills and Kanavos, 2020). Some studies on governance rely on country-level data, with limited insight into individual hospital management (e.g., Sharma et al., 2021).

In practice, there is ample evidence that sustainability and governance of healthcare systems is an important issue to consider from an interdisciplinary accounting perspective to understand the financial implications of alternative strategies. In the UK, over the last two decades, government reforms introduced efficiency measures and drastic spending cuts to close a funding gap of £30bn by 2021 (NHS England, 2013), which impacted long-term sustainability in the healthcare sector. Other government initiatives that aimed to encourage hospitals’ financial autonomy included the introduction of Payment by Results (PbR), a funding system that reimburses hospitals based on clinical activity, and various performance management and measurement tools such as Service Line Reporting and Patient-level Information and Costing Systems (Llewellyn et al., 2016; Begkos & Antonopoulou, 2021). However, the COVID-19 pandemic brought further strain and exacerbated the financial woes within this important sector. Since the onset of the pandemic, the National Health Service in the UK faced severe long-term pressures as it lacked a national strategy for dealing with health inequalities (Fichera, 2020).Therefore, research on issues of performance measurement, sustainability and governance in the healthcare sector both before and following the pandemic is crucial yet underexplored.

The aim of this special issue is to publish a collection of papers that focus on key questions related to performance measurement, sustainability and governance within the healthcare sector, and especially in response to the COVID-19 pandemic.

The Editors are interested in articles that focus on advancing our theoretical understanding and addressing policy issues in these crucial, yet under-researched themes. Below are some examples of topics that would be considered for the special issue.

  • Performance measurement practices in healthcare during the COVID-19 pandemic
  • Healthcare costing techniques for the increase of public value
  • Digitization and performance measurement technologies within healthcare settings
  • Alternative costing of healthcare services
  • Engagement of front-line professionals with costing and cost containment practices in healthcare settings
  • Incentives embedded within healthcare systems that drive financial reporting decisions
  • External accountability and communication across and after the COVID-19 pandemic: change, stability and international diversity
  • Accountability for healthcare outcomes in private, for-profit healthcare
  • Long-term financial sustainability of healthcare systems following the COVID-19 pandemic
  • International differences in sustainability of healthcare systems
  • Environmental sustainability of healthcare systems and possible change of priorities in light of climate change initiatives
  • Changes in corporate governance mechanisms of healthcare systems following the COVID-19 pandemic
  • Environmental, social and governance (ESG) performance and disclosure by healthcare institutions
  • Government authority and the digital media role in healthcare disclosures
  • International differences in governance structure of healthcare institutions

We are also open to other topics which fit the underlying general themes of this special issue.

Key Dates:

May 31, 2023: Deadline for submitting draft papers via Editorial Manager

June 2023 – June 2024: Review process and selection of articles to include in the special issue

It is anticipated that this special issue will be published in 2024.


· Public health systems

· Private health systems

· Pandemic response

· Post-pandemic healthcare costing systems

· Healthcare governance

· Digitization technologies

· Sustainability

· Performance management

· Performance measurement

· Cost Management

· Environmental impact

· Financial sustainability

· Climate change adaptation

· National Health Service

· Accountability

The British Accounting Review
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