Public hospital accounting reform: the case of Austria introduction of mandatory cash flow statements for hospitals

Aim

Each year, Austria’s 133 care-relevant hospitals receive approximately €9.7 billion in funds. During recent fiscal equalisation negotiations, an agreement on the further development of a public hospital accounting system was reached. Its central element was the introduction of mandatory cash flow statements, applicable to all care-relevant hospitals in Austria. Therefore, our research questions are: Why has the development of the existing accounting system become necessary? Why has the existing accounting information (in particular the hospitals’ cost accounting and annual balance sheets) been deemed as insufficient? Which advantages does cash based information offer in addition?

Subject and methods

By means of interventionist research, the public hospital accounting reform was actively accompanied from the initial fiscal equalisation negotiations right up to the drafting of the regulation (for issue) by the ministry.

Results

The standardisation of annual balance sheets and the analysis of the hospitals are very complex and offer only limited objective information. Cash flow statements deliver transparent information on the operating performance as well as the investment and financing behaviour. Market distortions such as subsidies for operating deficits to selected (inefficient) hospitals become identifiable.

Conclusion

Solid investment and financing policies of the hospitals become identifiable. The hospitals will be measurable for the flat rate payers and subsequently also better controllable via a potential incentive scheme.