In recent decades, reforms in the public sector place new demand on the manage-ment and control practices. Focusing on healthcare there are few investigations that analyse the context related to the design of such practices in a holistic sense. Thus, the aim of the paper is the comprehension of how management accounting and control practices change, even in their nature, as the result of reforms, specifically the introduction of L.R. 23/2015 related to the renew Lombardy Health System. A conceptual model inspired by the middle range thinking guides the analysis of the legislation, notes of interviews, conferences and informal meetings with practitioners. Nine months later the introduction of reform, regulations and the perception of involved practitioners seems oriented towards the design of management accounting and control practices with communicative nature.
Keywords: Health sector, management accounting, middle range, Performance Management Systems.