Measuring nothing: The case of the Greek National Health System

Several critical studies in accounting have approached the introduction of accounting systems in the public sector in terms of enforcing and sustaining competition-based resource allocation mechanisms. In this study, we reverse the question and ask: why has accounting not been used in certain public bureaucracies as much as it might? We investigate the extent to which accounting systems have been used in the management of the Greek National Health System (ESY) and find that accounting has played a marginal role in its development. Attempting to explain this puzzling feature we first note and then contrast the main underlying features of accounting systems with those of the Greek political system in general, and ESY in particular Briefly, our explanation is that the historically high politicization that has characterized the Greek political system has tended to overshadow the economic-cum-managerial dimension of running public bureaucracies, favouring overtly political evaluation criteria of organizational and individual performance. In such an institutional environment, accounting has low symbolic significance and its use does not contribute to enhancing organizational legitimacy - hence its marginal role.