This study analyses the relationship between institutionalization of budget cuts and sustainable accountability in public health care supply chain during the ongoing financial crisis. It uses the theory of negotiated order to extend the institutional framework of management accounting change proposed by Burns and Scapens (2000). Field research was conducted in Finland in two hospital districts, a local health care centre and a municipality, between 2012 and 2014. Data are based on document analysis and interviews with key decision makers and medical professionals.

The study shows that medical professionals use a negotiated order approach among themselves to institutionalize budget cuts in in hospital districts, which leads to sustainable accountability. At municipal and regional levels, however, budgets of primary health care services suffer from suffocation caused by political pressure to cut costs without sustainable accountability mechanisms in the supply chain of health care services.

Major contribution is to show how institutionalization of budgetary cuts in public health care cannot be taken for granted to save costs of health care services and improve sustainable accountability among political decision makers and medical professionals when the supply chain is not integrated. As in any other field study, however, our findings cannot be generalized to other organizations than the organizations analyzed.