The effect of rules, habits and bureaucracies on costing in the UK National Health Service

The widespread adoption and implementation of costing systems in the UK National Health Service (NHS) has been an important part of the response to the structural changes brought about in the health sector over the last 20 years. One key feature of costing systems in this context is to provide a guide by which efficiency and effectiveness may be measured against a background of decision making in a public service environment where the public service provision ethos is important. Re‐assesses the role of costing systems in the NHS in the light of research on rules and habit formation in the decision‐making process. In developing these points further argues that bureaucracies provide an important linkage in marshalling implicit habitual behaviour to multiple‐organisational goals. In so doing, bureaucratic structures represent part of the mechanism which facilitates effective organisational performance. Such performance is made efficient through the use of accounting systems which measure performance and provide signals for resource allocation via quasi‐costs (or the internal quasi‐transfer prices), although the extent of the usefulness of such signals is questioned. In particular, argues that there is no connection between the market, such as it is, and intra‐hospital resource allocations, at least not in a direct manner, nor in any manner in the short term.