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Axel C. Hüntelmann

What does the Charité’s cabbage garden have to do with medical knowledge and economy? And how are accounting, economy, and health interconnected beyond current discussions about economisation? Bringing together health, medicine, and accounting, the chapter on hospital economies investigates the Charité hospital’s various economies between 1780s and 1910: its Ökonomie of functional entities, like the kitchen, laundry, brewery; the bodily economy of its sick inmates; and the hospital’s administrative economy that, after 1900, professionalised as ‘hospital economics’. Hüntelmann argues that all of these economies were linked together and that health and accounting have long been deeply entangled with one another. The chapter demonstrates this by focusing on inmates’ food and diet: in the hospital’s Ökonomie, the production and supply of food was registered and balanced against consumption; daily consumption rates and diets were calculated for each person, monetised, and used to derive daily cost-rates and patient fees; annually budgeted and retrospectively balanced. Surveying more than a century, we find that calculative practices and accounting at the Charité hospital were remarkably stable. But there are also major changes over time as the collection of data became more formalised – as the entire process of organising food production, calculating diets, and accounting for food-stocks became more standardised, not least because it involved more people gathering and transforming the necessary dates – and professionalised as ‘hospital economics’. And as the 1780s hospital Ökonomie diminished over time, from the early decades of the twentieth century it mainly existed on paper, interlinked by and represented in the hospital’s accounts.

in Accounting for health
Calculation, paperwork, and medicine, 1500–2000

Accounting is about ‘how much’ and is usually assumed to be about money. It is viewed as a financial technology related to the administration of finances, costing, and the calculation of efficiency. But this book suggests a broader understanding of accounting, linking related perspectives and lines of research that have so far remained surprisingly unconnected: as a set of calculative practices and paper technologies that turn countable objects into manageable units, figures, and numbers that enable subsequent practices of reckoning, calculating, valuing, controlling, justifying, communicating, or researching and that generate and appear in account- or casebooks, ledgers, lists, or tables.

And Accounting for Health involves both money and medicine and raises moral issues, given that making a living from medical treatment has ethical ramifications. Profiting from the ‘pain and suffering of other people’ was as problematic in 1500 as it is in today’s debates about the economisation of medicine and the admissibility of for-profit hospitals. In current debates about economisation of medicine, it is hardly noticed that some versions of these patterns and problems has been with health and medicine for centuries – not only in the modern sense of economic efficiency, but also in a traditional sense of good medical practice and medical accountability.

Spanning a period of five centuries (1500–2011) and various institutional settings of countries in the Western world, Accounting for Health investigates how calculative practices have affected everyday medical knowing, how these practices changed over time, and what effects these changes have had on medicine and medical knowledge.

Abstract only
Axel C. Hüntelmann and Oliver Falk

Accounting is about ‘how much’ and is usually assumed to be about money, the administration of finances and the calculation of efficiency. This introduction suggests a broader understanding of accounting, especially in relation to health, medicine, and medical knowledge; and elaborates its characteristics by using the example of poor boxes in front of hospitals: money going in and out. But donations were made for a certain purpose and laden with moral or social intentions. Therefore, treasurers had to provide information about the donor’s gift to account for its efficient and legitimate use. Accounting for health involved information being collected, listed, and compiled in order to demonstrate good medical practice. Thus, monetary income is correlated with medical outcome. More generally, accounting for health is described as a set of calculative practices and administrative techniques in which money, goods, and other countable objects or patients, detached from their physical materiality, are transformed in specific codes and formats that appear in ledgers, account-books, or tables. Such an expanded meaning of accounting allows to trace the entwined monetary, moral, and epistemic dimensions of accounting (for health) and illuminates the linkage of accounting, health, and medical knowing and its deeply entangled history for over five centuries.

The introduction summarizes the various strains of sociological and historical research and literature on the history of (hospital) accounting and paper technologies. Discussing methodological issues, the introduction elaborates the longue durée perspective and the praxeological approach of the volume’s chapters and gives an overview about the structure of the book.

in Accounting for health