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Paper short abstract:

This paper aims to explore and conceptualize how hospital organizations have turned into measuring and accounting entities, and how this has set into motion an experiment of developing and enacting internal surveillance infrastructures, producing new notions of good care

Paper long abstract:

In various countries hospitals have moved from service organizations serving the public good to competing enterprises that must account for their actions to various third parties (i.e. health insurers, the media, financial authorities, the Inspectorate). In this paper we aim to explore and conceptualize how hospital organizations have turned into measuring and accounting entities, and how this has set into motion an experiment of developing and enacting internal surveillance infrastructures. These experimental infrastructures (Jensen and Winthereik 2013; Jensen and Morita 2015), we show, are complex heterogeneous assemblages of technologies, regulations, professional authority, calculating instruments and control practices.

Empirically, we draw on a study of financial accounting in the Netherlands. Hospitals, and more in particular medical practitioners, must register medical treatment in order to get care reimbursed. In the recent past, hospitals have been accused of committing fraud through practices of 'upcoding' (i.e. registering more expensive treatments than actually provided), evoking a myriad of regulations and control practices by external regulating authorities. In this paper we show how hospital organizations attempt to embody regulation and control by fashioning technological surveillance systems (e.g. an electronic patient file that warns physicians for 'incorrect' registering) as well as calculable spaces to predict and measure performance in order to optimize financial results. We demonstrate how this enactment of calculating selves and calculative spaces (Asdal 2011; Miller 1994) has induced an infrastructure of liquid surveillance (Bauman and Lyon 2012), producing new notions of 'good care'.