CfP: Accounting for Health: Economic Practices and Medical Knowledge, 1500–1970
Call for Participants in a Working Group on
Accounting for Health: Economic Practices and Medical Knowledge, 1500–1970
Convening for three workshops in Berlin, 2016-2017
Organised by Oliver Falk & Axel C.
Hüntelmann, ERC Research Group PAPERTECH: “Ways of Writing: How
Physicians Know, 1550–1950.”
Accounting is about how much. Healthcare
today seems caught between too much and not enough. On the one hand,
there are swollen national health budgets, massive hospital and medical
technology costs, big pharma, and an ever-growing
market of medical products and services; on the other hand, lack of
access to healthcare can be found across the globe, as can political
challenges of resource allocation, ethical dilemmas of “rationing,” and
the search for solutions of cost reduction, more
equal distribution, and efficiency between the poles of government
regulation and market principles. Critics argue that “economization” of
medicine limits the growth of medical knowledge and its benefits.
It is hardly noticed in current debates that
some version of these patterns and problems of economy has been with
health and medicine for centuries – not only in the modern sense of
economic efficiency, but also in a traditional
sense of good medical practice. Moreover, the perceived patterns,
problems, and solutions have all been enabled by various forms of
accounting – in the narrower sense of bookkeeping methods and in the
broader sense of economic, political, and moral monitoring,
calculating, and decision-making. And these, in turn, appear to have
shaped medical knowledge and practice in ways too little understood. We
invite scholars from a wide variety of relevant fields to join a working
group to examine this longue durée of medicine
and economy, focusing on practices and values of economic and medical
knowing.
With this focus, the group will bring
together related perspectives and lines of research that have been
surprisingly disconnected hitherto: historical and social study of
health economics, markets, and regulation or “economization”;
history and sociology of accounting, including work specifically on
hospital accounting; study of the rise of political arithmetic and vital
statistics; of quantification in clinical medicine as well as in public
health and epidemiology; of risk calculation
and insurance. All of these will be brought together more broadly with
historical and social studies of information, data, and paper
technology.
Questions to be addressed include: What
variety of roles have accounting and similar economic practices played
in everyday medical knowing? In knowing what to do in health care
institutions? Since when and why? How do such practices
generate information about medical costs and in what ways are such data
transformed into economic knowledge? How has this economic practice and
knowledge affected medical knowledge and practice, whether in diagnosis
and disease classification, or human and
animal physiology and its “applied” fields and uses, the conceptual and
economic organization of medical research, the nature of prognosis and
treatment, patients’ self-observation and self-medication, and so on? Or
looking beyond such effects, have medical
and economic knowing been more deeply integral to each other and, if
so, exactly how? Under what conditions have these relationships and
processes become visible and contested or consciously shaped by actors
for specific ends? What changes can be observed
over time, and what differences across countries or political and
economic systems?
Accounting happened on paper, at least in
the period of proposed study. It involved not only specific methods of
counting and numerical calculation, but also wider practices of
information and data, including note-taking and the
keeping, organizing, and using of notebooks, files, and archives,
reading and writing, tabularization and transfer among different kinds
of tabular and narrative representation. Practices of data, writing, and
information have become the subject of increasingly
intensive historical and social research over the past 10 years. These
are not the subject per se of the proposed working group, but they are
its material focus. More concretely, in the sphere of accounting,
information practices produce cost calculations
for medical treatments (and indeed the very definition of units of
medical care), tables of figures about the patient, construction of
vital and medical statistics, the accounting of charges for insurance
companies and their setting of rates, and classification
of information and data about patients.
Proposals for participation in the working
group will therefore ideally specify the sorts of material to be
studied: from practitioner notebooks to hospital ledgers; from files and
tables to budgets, but also reports, charts,
publications, records of meetings and debates. Research questions will
go beyond revealing forms and practices to address what has been at
stake in them. Accounting looks both backward and forward in time,
comprising both accountability and projection or forecasting;
it puts a variety of values and expectations on paper in ways that
operate immediately and long-term on disease and survival, always
through the knowing that happens around these. Accounting and related
practices thus shape what medicine is and, for actors
in given times and places, ought to be.
The working group will convene three times
in 2016–17 in Berlin with the purpose of producing a truly collective
volume. The contributions will be discussed at the workshops, with
feedback from participants and invited commentators.
The working group is an initiative of the research project “Ways of
Writing: How Physicians Know, 1550–1950,” funded by the ERC (for further
information about the project see: http://papertechnology.
Meetings will take place in June (17th–19th)
2016, in December (2nd–4th) 2016 and in late Spring 2017. Travel and
accommodation will be reimbursed.
Proposals of up to 300 words should be sent by 11th March 2016 to axel-caesar.huentelmann@