A REFORMING ACCOUNTABILITY - GPS AND HEALTH REFORM IN NEW-ZEALAND

Over the last ten years or so, many countries have undertaken public s ector reforms. As a result of these changes, accounting has come to pl ay a more important role. However, many of the studies have only discu ssed the reforms at a conceptual level and have failed to study how th e reforms have been implemented and operated in practice. Based on the work of Lipsky (1980) and Gorz (1989), it can be argued that those af fected by the reforms have a strong incentive to subvert the reforms. This prediction is explored via a case study of general practitioner ( GP) response to the New Zealand health reforms. The creation of Indepe ndent Practice Associations (IPAs) allowed the State to impose contrac tual-accountability and to cap their budget exposure for subsidies. Fr om the GP's perspective, the IPAs absorbed the changes initiated by th e State, and managed the contracting, accounting and budgetary adminis tration responsibilities that were created. This allowed individual GP s to continue practising as before and provided some collective protec tion against the threat of state intrusion into GP autonomy. The creat ion of IPAs also provided a new way to manage the professional/financi al tension, the contradiction between the professional motivation note d by Gorz (1989) and the need to earn a living. ((C) 1997 by John Wile y & Sons, Ltd.)