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Hospital accounting and auditing as practiced today in the United States was relatively unknown as recently as 1950. Prior to the mid-1950's there was little resemblance between not-for-profit hospital accounting and accounting practices followed by organized-for-profit firms. Unlike other industries, hospital accounting has not, until recently, been greatly influenced by the professional accounting organizations. Instead, the American Hospital Association, the Blue Cross Plans, and government Medicare have played the greatest roles in the development of accounting principles. This study examines some of the differences between hospital accounting principles and generally accepted accounting principles in the USA during the period since the late 1800s.