Conference Agenda

This longitudinal case investigates the role of rolling forecasting in a budget abandonment process. The data gathering is primarily based on interviews covering all major persons participating in these processes in a multinational industrial corporation. Our study reveals how agents’ temporal orientations (past, present, and future) create tensions that explain why, as rolling forecasting is introduced, some elements of annual budgeting persist while others change. We contribute to prior studies in the empirical literature on Beyond Budgeting and budget abandonment by shedding light on the role of rolling forecasting in these processes. We also add to the prior accounting literature by discussing the paradox of embedded agency in an empirical accounting study. Furthermore, we contribute to the literature that has addressed the disconnect between strategy and forecasting practices by showing how new rolling forecasting mechanisms work to solve this tension

Introduction

Overtreatment, overdiagnosis, and overutilization are driving the cost increase and the burden on health insurance; hospital treatment needs to be transparent. Hospitals face the challenge of designing a strategy and appropriate management control tools. The Hospital management needs to adopt modern techniques of control in management to meet the demands of multiple goals (Yaman, 2014). Chinese public hospitals intended to use the new payment method (Diagnosis-Related Group) to improve the transparency and financial performance. This paper intends to use a case study to explore the question of whether the DRG-based payment, as a new technique tool in the management control package, can reduce corruption to improve the healthcare insurance financial performance. Use three models to discover control factors linkages in Chinese public hospitals to better use the DRG.

Background

In the Chinese public hospital context, hospitals use the workload to compensate clinicians due to the government's reduction in financial funding. However, a lack of monitoring led to overtreatment and corruption. Frimpong and Jacques (1999) point out that corruption can be treated as a function of an organization that lacks proper procedures and policies, or an organization that has excessive discretionary power, inadequate oversight, and a lack of transparency. A city named Sanming in southern China uses the DRG-based payment in 14 hospitals to reshape the control elements, and achieved positive financial performance.

Methodologies

The empirical research, using longitudinal data from 2019 to 2024 and data from approximately 14 hospitals in Sanming City, categorizes hospitals by level. Data were collected using the Sanming Municipal Health Commission website and the Sanming Public Hospital management monitoring platform. Data analysis was performed based on analysis with SPSS 21 software and Stata, using the fixed model.

Findings

Model 1 - IR

It was found that the Bed Utilization had a significant negative linear correlation (β = -42.893, P = 0.008) with IR, and the Total Service Income had a significant Positive linear correlation (β = 0.239, P = 0.000) with IR. R2=0.79

Model 2 - TSI

It was found that the Per Bed Daily Income had a significant Positive linear correlation (β = 25.665, P = 0.000) with TSI, and the Emergency Inpatient Rate had a significant negative linear correlation (β = -211.579, P = 0.008) with TSI. R2=0.774

Model 3 - IpAC

It was found that the Surgery Cost had a significant Positive linear correlation (β = 0.740, P = 0.000) with IpAC, and the Bed Utilization had a significant Positive linear correlation (β = 104.832, P = 0.000) with IpAC. R2=0.618.

Conclusion

This study was carried out to investigate the factors affecting hospital performance from three perspectives. The use of DRG provides a new solution for hospital managers to better achieve the different goals. Reorganizing the work process and design performance evaluation is needed. The context changed, and the hospital needs to know which strategy is better for sustainable development. Understand the linkages and use them to better control.

China’s recent health reforms promote Integrated Healthcare Systems (IHS) and mandate digital transformation (DT) as a technical backbone to address inefficiencies in care delivery. While prior accounting research has explored how individual technologies reshape digitisation, digitalisation, and transformation processes, it often conflates these phases and under-theorises the role of datafication. To address this gap, this study adopts a processual view of DT to investigate how layered digital infrastructures and multiple institutional logics interact to reshape accounting and control practices in the public healthcare sector.

Drawing on institutional logics theory and Begkos et al.’s (2024) three-layer model of DT (digital artefacts, infrastructures, and hybrid organisational forms), we examine a three-year qualitative case study of a second-tier public hospital designated as an IHS pilot in China.

The findings offer a processual account of digital transformation as a layered and negotiated phenomenon unfolding across digitisation, digitalisation, and datafication. In advancing IHS, the hospital establishes a regional data-sharing centre and integrated information platform that consolidates cost, capacity, and quality indicators to improve service coordination and operational efficiency. Moreover, the findings demonstrate how digitalisation emerges as a distinct institutional logic that reconfigures—rather than merely reinforces—existing state, managerial, and professional logics in public healthcare delivery. This study contributes to accounting research on DT by shedding light on how digitalisation logic is institutionalised through hybrid organisational arrangements that enable the coexistence and reconciliation of competing logics, thereby reshaping management accounting and control practices in public healthcare organisations.