THE DIAGNOSIS-RELATED GROUP-PROSPECTIVE PAYMENT SYSTEM AND THE PROBLEM OF THE GOVERNMENT OF RATIONING HEALTH-CARE TO THE ELDERLY

In this study, we seek to explore further accounting's role in the ind irect government of socio-economic life. The introduction of Medicare in 1965 was an important component of President Lyndon B. Johnson's '' Great Society Program''; whereas the introduction of the Diagnosis Rel ated Group-Prospective Payment System (DRG-PPS) was part of President Ronald Reagan's ''Tax Equity and Fiscal Responsibility Act,'' which re vised the relationships among the federal government, health care prov iders and the elderly population at large. DRG-PPS simultaneously rede fined the relations of health care while effacing the rationing decisi ons inherent in these redefinitions. As our analysis suggests, account ing-based data and calculations contributed to ''government at a dista nce'' and helped to alleviate the difficulties inherent in overtly rat ioning health care to the elderly. By examining the location of accoun ting in this process we conceptualize and detail how accounting operat ed as form of distributive government within the domain of health care . (C) 1997 Elsevier Science Ltd.