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This paper develops and tests a descriptive model of management accounting system choice through an empirical analysis of the adoption of innovative cost accounting systems in not-for-profit hospitals. The logistic regression analysis indicates that management accounting system design is impacted by organi zational objectives, technological complexity, and other features of the organizational control system. Descriptive statistics indicate limited use of management accounting techniques common in manufacturing firms, such as standard costing and variance analysis. A cross-lagged model suggests that implementation of an innovative management accounting system may be causally linked to decreasing operating costs.

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