Joris Vandendriessche
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Accounting practices in the Leuven Academic Hospitals, 1920–60
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This chapter scrutinises the role of accounting in the expansion of academic health care in the mid-twentieth century. Taking the hospitals run by the Catholic University of Leuven (Belgium) as a case study, it analyses the impact of a professionalising administration – accountants, economists, and managers included – on hospital governance. Its main argument is that accounting practices proved crucial for the establishment of the modern academic health centre as they enabled a centrally directed redistribution of means and responsibilities, in line with the health policies of the Belgian postwar welfare state and academic educational reforms. The chapter shows how the aggregate budgets, preprinted forms, and ‘strength reports’ designed by postwar bookkeepers effectively shaped new hospital realities. While new specialised medical services received more (financial) autonomy, the opportunities for expansion of other services were limited. The chapter further shows how such top-down and performative accounting differed from (and clashed with) professors’ prewar managerial roles. The autonomy of the latter as the directors of their own medical institutes was gradually limited. A heated debate over a centralised accounting department of the Leuven hospital for collecting the fees stemming from Belgian Social Security in 1944 illustrated the erosion of prewar hospital governance. Henceforth, centralised accounting became key to setting in motion the wheels of medical expansion.

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Accounting for health

Calculation, paperwork, and medicine, 1500–2000

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