One important tool to enhance performance in hospitals is the management accounting
system . Kettelhut (1992) suggested that there are three basic requirements for
hospitals accounting systems. First, it must continue to support traditional tasks like
tracking patients, billing, payroll, and other accounting functions. Second, it must be used
to increase hospital marketing effectiveness. Third, it must be used to measure and
improve hospital efficiency. Ramsey (1994) proposed that accounting systems should
serve three purposes: