FINANCIAL INFORMATION IN PUBLIC HEALTHCARE ORGANISATIONS: DEMAND, REGULATION AND THE WORKING CAPACITY OF THE ACCOUNTING METHOD
DOI:
https://doi.org/10.5281/zenodo.22875488Abstract
Public healthcare organisations in transition economies are increasingly expected to produce financial information that supports tariff setting, capacity planning and performance assessment, while the statutory reporting framework has traditionally been oriented toward confirming budget execution. This paper examines the extent to which the accounting system of a public medical organisation fulfils its informational function and identifies areas in which its analytical and managerial potential can be further strengthened. The study draws on the complete 2019–2025 reporting archive of four Uzbek public medical organisations, comprising more than 250 primary statutory reports, of which 73 filings across eight form families constitute the main research object. The analysis proceeds on three levels: the demand for information, the regulatory architecture of accounting, and the working capacity of the eight classical elements of the accounting method. Three main findings are reported. First, institutional information is produced in three layers that could benefit from closer methodological coordination, while two of the six identified classes of management decisions are fully supported by the statutory report set. Second, the third tier of regulation, which is developed at the organisational level, demonstrates considerable potential for further formalisation: accounting policy, the document-flow schedule and internal control procedures were not identified in the examined archives, whereas externally regulated accounting requirements were consistently observed. Third, among the eight elements of the accounting method, one operates fully, five operate partially, and two are not directly reflected in the statutory reporting forms; a separate costing mechanism was not identified in the available documentation. Because accrued depreciation is not included in expenditure, the reported cost of services may be 7.4–11.0 per cent lower than a full-cost measure, while the depreciation ratio increased from 44.2 to 61.5 per cent over five years. Inter-form articulation tests indicate that the principal opportunity for improving informational consistency arises at the aggregation stage rather than at the ledger level. The paper concludes that the existing system provides a reliable basis for monitoring the allocation and use of financial resources, while further development of cost accounting and analytical reporting could expand its capacity to assess the economic results of healthcare service delivery.Keywords
public sector accounting, budgetary accounting, healthcare financing, financial reporting quality, accountingReferences
1. Anessi-Pessina, E., & Steccolini, I. (2007). Effects of budgetary and accruals accounting coexistence: Evidence from Italian local governments. Financial Accountability & Management, 23(2), 113–131. https://doi.org/10.1111/j.1468- 0408.2007.00422.x
2. Anthony, R. N., & Young, D. W. (2003). Management Control in Nonprofit Organizations (7th ed.). Boston: McGraw- Hill/Irwin.
3. Barton, A. (2009). The use and abuse of accounting in the public sector financial management reform program in Australia. Abacus, 45(2), 221–248. https://doi.org/10.1111/j.1467-6281.2009.00283.x
4. Brusca, I., & Martínez, J. C. (2016). Adopting International Public Sector Accounting Standards: A challenge for modernizing and harmonizing public sector accounting. International Review of Administrative Sciences, 82(4), 724–
5. https://doi.org/10.1177/0020852315600232
6. Carnegie, G. D., & West, B. P. (2005). Making accounting accountable in the public sector. Critical Perspectives on Accounting, 16(7), 905–928. https://doi.org/10.1016/j.cpa.2004.01.002
7. Chapko, M. K., Liu, C.-F., Perkins, M., Li, Y.-F., Fortney, J. C., & Maciejewski, M. L. (2009). Equivalence of two healthcare costing methods: Bottom-up and top-down. Health Economics, 18(10), 1188–1201. https://doi.org/10.1002/ 351 SOCIAL, ECONOMIC, SCIENTIFIC, AND TECHNICAL ACADEMIC JOURNAL 9/2026 hec.1422
8. Christiaens, J., & Rommel, J. (2008). Accrual accounting reforms: Only for businesslike (parts of) governments. Financial Accountability & Management, 24(1), 59–75. https://doi.org/10.1111/j.1468-0408.2008.00443.x
9. Christiaens, J., Vanhee, C., Manes-Rossi, F., Aversano, N., & Van Cauwenberge, P. (2015). The effect of IPSAS on reforming governmental financial reporting: An international comparison. International Review of Administrative Sciences, 81(1), 158–177. https://doi.org/10.1177/0020852314546580
10. Debreceny, R., Farewell, S., Piechocki, M., Felden, C., & Gräning, A. (2010). Does it add up? Early evidence on the data quality of XBRL filings to the SEC. Journal of Accounting and Public Policy, 29(3), 296–306. https://doi. org/10.1016/j.jaccpubpol.2010.04.001
11. Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the Economic Evaluation of Health Care Programmes (4th ed.). Oxford: Oxford University Press.
12. Grossi, G., & Soverchia, M. (2011). European Commission adoption of IPSAS to reform financial reporting. Abacus, 47(4), 525–552. https://doi.org/10.1111/j.1467-6281.2011.00353.x
13. Hepworth, N. (2003). Preconditions for successful implementation of accrual accounting in central government. Public Money & Management, 23(1), 37–44. https://doi.org/10.1111/1467-9302.00339
14. Hyndman, N., & Connolly, C. (2011). Accruals accounting in the public sector: A road not always taken. Management Accounting Research, 22(1), 36–45. https://doi.org/10.1016/j.mar.2010.10.008
15. International Federation of Accountants (IFAC), & Chartered Institute of Public Finance and Accountancy (CIPFA). (2021). International Public Sector Financial Accountability Index: 2021 Status Report. New York: IFAC.
16. International Monetary Fund (IMF). (2014). Government Finance Statistics Manual 2014. Washington, DC: International Monetary Fund. https://doi.org/10.5089/9781498343763.069
17. International Public Sector Accounting Standards Board (IPSASB). (2015). Recommended Practice Guideline 3: Reporting Service Performance Information. New York: IFAC.
18. International Public Sector Accounting Standards Board (IPSASB). (2023). IPSAS 45: Property, Plant, and Equipment. New York: IFAC.
19. International Public Sector Accounting Standards Board (IPSASB). (2023). The Conceptual Framework for General Purpose Financial Reporting by Public Sector Entities. New York: IFAC.
20. Ivanković, D., Poldrugovac, M., Garel, P., Klazinga, N. S., & Kringos, D. S. (2020). Why, what and how do European healthcare managers use performance data? Results of a survey and workshop among members of the European Hospital and Healthcare Federation. PLOS ONE, 15(4), e0231345. https://doi.org/10.1371/journal.pone.0231345
21. Jones, R., & Pendlebury, M. (2010). Public Sector Accounting (6th ed.). Harlow: Pearson Education.
22. Jorge, S., Jesus, M. A., & Nogueira, S. P. (2016). Information brokers and the use of budgetary and financial information by politicians: The case of Portugal. Public Money & Management, 36(7), 515–520. https://doi.org/10.1080/0954096 2.2016.1237152
23. Kidholm, K., Ølholm, A. M., Birk-Olsen, M., et al. (2015). Hospital managers’ need for information in decisionmaking: An interview study in nine European countries. Health Policy, 119(11), 1424–1432. https://doi.org/10.1016/j. healthpol.2015.08.011
24. Lapsley, I., Mussari, R., & Paulsson, G. (2009). On the adoption of accrual accounting in the public sector: A self-evident and problematic reform. European Accounting Review, 18(4), 719–723. https://doi.org/10.1080/09638180903334960
25. Lüder, K. (1992). A contingency model of governmental accounting innovations in the political-administrative environment. Research in Governmental and Nonprofit Accounting, 7, 99–127.
26. Mogyorosy, Z., & Smith, P. C. (2005). The Main Methodological Issues in Costing Health Care Services: A Literature Review. CHE Research Paper No. 7. York: Centre for Health Economics, University of York.
27. OECD, Eurostat, & World Health Organization (WHO). (2017). A System of Health Accounts 2011: Revised Edition. Paris: OECD Publishing. https://doi.org/10.1787/9789264270985-en
28. Ostonokulov, A. A. (2020). Application of international public sector accounting and reporting standards under budget accounting reform. Moliya, 4, 45–52.
29. Otley, D. T. (1980). The contingency theory of management accounting: Achievement and prognosis. Accounting, Organizations and Society, 5(4), 413–428. https://doi.org/10.1016/0361-3682(80)90040-9
30. Ouda, H. A. G. (2021). Practice-Relevant Accrual Accounting for the Public Sector: Producers’ and Users’ Perspectives. Cham: Palgrave Macmillan. https://doi.org/10.1007/978-3-030-51595-9
31. Paliy, V. F. (2007). Theory of Accounting: Contemporary Problems. Moscow: Bukhgalterskiy Uchet.
32. PEFA Secretariat. (2016). Framework for Assessing Public Financial Management. Washington, DC: PEFA Secretariat.
33. Pettersen, I. J. (2001). Implementing management accounting reforms in the public sector: The difficult journey from intentions to effects. European Accounting Review, 10(3), 561–581. https://doi.org/10.1080/713764632
34. Redman, T. C. (1998). The impact of poor data quality on the typical enterprise. Communications of the ACM, 41(2), 79–82. https://doi.org/10.1145/269012.269025
35. Sokolov, Ya. V. (2000). Foundations of the Theory of Accounting. Moscow: Finansy i Statistika.
36. Steccolini, I. (2019). Accounting and the post-new public management: Re-considering publicness in accounting research. Accounting, Auditing & Accountability Journal, 32(1), 255–279. https://doi.org/10.1108/AAAJ-03-2018-3423
37. Tan, S. S., Rutten, F. F. H., van Ineveld, B. M., Redekop, W. K., & Hakkaart-van Roijen, L. (2009). Comparing methodologies for the cost estimation of hospital services. The European Journal of Health Economics, 10(1), 39–45.
38. Van Helden, J. (2016). Literature review and challenging research agenda on politicians’ use of accounting information. 352 9/2026 Public Money & Management, 36(7), 531–538. https://doi.org/10.1080/09540962.2016.1237162
39. Van Helden, J., & Reichard, C. (2019). Making sense of the users of public sector accounting information and their needs. Journal of Public Budgeting, Accounting & Financial Management, 31(4), 478–495. https://doi.org/10.1108/ JPBAFM-10-2018-0124
40. Wang, R. Y., & Strong, D. M. (1996). Beyond accuracy: What data quality means to data consumers. Journal of Management Information Systems, 12(4), 5–33. https://doi.org/10.1080/07421222.1996.11518099
41. World Health Organization (WHO). (2024). World Health Statistics 2024: Monitoring Health for the SDGs, Sustainable Development Goals. Geneva: World Health Organization.
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