According to the conviction that accounting isn’t necessarily subordinate to economics, the chapter does not deal with accounting practices in a classical sense but aims to highlight the use and value of calculative practices in treatment and research. By examining Elliott Joslin’s principles and practices of diabetes therapy, it shall be shown how he used calculative and administrative techniques as a tool to combine both therapeutic measures and scientific investigation. Drawing on archival materials of the Joslin Diabetes Center, as well as on Joslin’s published manuals, textbooks, and early seminal articles, it shall, first, be shown how Joslin systematised his patient files for comparing cases and evaluating new therapies. Second, it will be shown how Joslin begun to conceptualised diabetes in rather epidemiological and socio-medical terms at the same time, which subsequently led to new collaborations between physicians, government authorities, life insurance companies, and patients bound together by accounting practices. Finally, it is focused on Joslin’s relationship with his patients and how the qualitative and quantitative information he gathered could be used in therapy and research.
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.
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.