Accounting Dilemma and Health Care’s Accounting Control

This study aims to describe the phenomenon of accounting dilemma in the accountingization process of health services as part of the implementation of New Public Management in Indonesia. This study uses the case study method in two public hospitals owned by the Provincial Government in Indonesia. The results show that the dilemma is related to the doubts of accountants regarding the implementation of quality control and cost control as the implications of the national health insurance system implemented by the government. Conflicts of interests, idealism, society’s interests, and the demands of the government make various accounting tools is only used as forms of ritual and legitimacy. This study uses a case study in two government hospitals as a portrait of the implementation of accounting for health services in Indonesia. This study portrays the phenomenon of accounting dilemma that occurred and suggested in the next study to produce an accounting system that is in accordance with government-owned health services. The researchers proposed a more appropriate management accounting system to government health services by considering public health sector management accounting (PHSMA). The PHSMA contains (1) the use of an organizational system with privatization at the medium level while promoting social aspects, (2) the use of government funding in the form of health operational funds to support universal health coverage (UHC), (3) using public health indicators as a basis for performance assessment and not merely use financial performance. This study emphasizes that government participation is still needed in supporting health quality improvement programs in the community through full support for health services. The sustainability of national health insurance system must be maintained. The accounting dilemma is a new concept that can be considered in the decision-making process of government institutions and can be followed up in subsequent research. Accounting dilemma is an event where an accounting system or practices should be selected under the pressure from the government, service users, and the management (internal pressure), but all of the options are equally unpleasant, not in accordance with the theory, or not in accordance with the existing data.