Accountability relationships and populism in the Greek National Health System. Evidence from the 1980s

Abstract

The aim of this thesis is to examine accountability in the Greek National Health system in regard to the emerging managerialism that prevailed in the Western countries since the 1980s. The distinction between political and managerial accountability has been utilised for the conceptualisation of empirical data. The theory of populism was used in order to interpret accountability relationships and explain the impact of the political environment on accountability. Parliamentary debate and the press of the period were examined, and they demonstrated that populism was a dominant force in the public debate. Populism was expressed as fierce polarisation on behalf of the government towards the opposition and it constituted a major way of political accountability. In this context, accounting was not a part of the legitimation scheme and there was direct clash between populism and the discourses of accounting. We also examined how this context was transfused into organisational practices. For this reason, we conducted interviews with people who were involved in the System. Analysis has shown that populism also had significant impact on organisations, as it was translated to severe partisanism and created clientelistic networks which monopolised power. Political accountability infiltrated in organisations through populism, dominated all aspects of accountability and it was turned to partisan accountability. As a result, managerial accountability was overshadowed, and it was never allowed to operate as a system for more efficient control. In fact, managerialism was victimised as a potential threat to the existing status. This thesis contributes to the examination of accountability beyond the Anglo-Saxon context, which dominates scientific literature. Additionally, it provides insights regarding the impact of politicians on accountability and accounting. Moreover, it proposes populism as a new theoretical framework for accountability, because it can have significant impact in a specific setting. Consequently, this thesis aims at further improving the understanding of accounting within the context in which it operates.