Implementation of Management Accounting in the Hospital Setting: A Case Study of a Medical Imaging Department within a Moroccan Public SEGMA Hospital

Abstract

This article examines the implementation conditions of cost accounting (CA) in a Moroccan public hospital (SEGMA), through a case study of a medical imaging department. In a context of health system reform and the expansion of Mandatory Health Insurance (AMO), controlling hospital costs has become a strategic issue. The objective of this research is to analyze the benefits, obstacles, and enablers of analytical cost management in a transitioning hospital environment. To achieve this, a mixed-method approach was used, combining an analysis of direct and indirect costs associated with medical procedures and semi-structured interviews conducted with healthcare professionals. This dual approach allows for the cross-referencing of financial data with the perceptions of hospital actors. Quantitative results reveal a significant imbalance between production costs and AMO reimbursement rates, with losses recorded for several procedures (notably MRI and ultrasound). The study also shows that the depreciation costs of equipment and buildings place a substantial burden on the department’s budget. Qualitative data indicate that cost accounting remains largely unfamiliar to medical professionals, most of whom were trained without a management-oriented perspective. Major barriers persist, such as the lack of training, resistance to change, and weak interdepartmental coordination. In conclusion, this study highlights the importance of cost accounting as a lever for performance and financial sustainability in the hospital sector. It advocates for a broader adoption of this tool in public health institutions, through targeted training programs, modernization of information systems, and better integration between clinical, administrative, and financial dimensions.

Classification JEL: I18, H51, M41, L32, D24

Paper type: Empirical Research