Gaming, Accountability and Trust: DRGs and Activity‐Based Funding in Norway

This paper examines a particular performance management instrument in Norway: DRGs used in conjunction with activity‐based funding of hospitals. We ask whether this system creates opportunities for undesirable gaming practices, how accountability arrangements deal with gaming, and how trust and institutional logic may help to explain anomalies and their resolve. From an instrumental and cultural perspective, we examine six Norwegian cases of gaming and two governmental assessments of coding and activity‐based funding. Current solutions do provide gaming opportunities, in a highly complex accountability setting. Accountability arrangements highlight tensions between trust and distrust, rather than resolving the balance between individual goals and collective norms.