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Out-of-pocket (OOP) payments continue to be a major method of financing healthcare in many low- and middle-income countries including Malaysia. Although macro-level data show that this is a substantial percentage of national health expenditure, at the grassroots level, the amount spent on health by households remains unknown in Malaysia. The purpose of this paper is to assess the validity and reliability of an adapted-for-purpose questionnaire designed to capture urban household health expenditures (HHEs) among Malaysian households.

This two-part study assessed content validity of the questionnaire using three experts and the reliability of the questionnaire through a test-retest study among 50 OOP-paying patients followed up at one private primary care clinic in Kuala Lumpur. This study was approved by the Malaysian Research Ethics Committee (NMRR-16-172-29311-IIR).

The validity of the 83-item questionnaire was high, with an item content validity index of 1.00 and a scale content validity index average score of 1.0 agreed to among the evaluating experts. In the test-retest reliability study, the majority of the categorical questionnaire items had perfect agreement values (k=0.81-1.00). Continuous questionnaire items were also found to be highly reliable with no significant differences between the test-retest segments and high correlation coefficient values (intra-class correlation coefficient>0.7).

The HHE questionnaire had excellent content validity and very high test-retest reliability. The results of this study suggest that this questionnaire could be used in Malaysian studies to determine actual urban HHE which is a first step toward developing universal health coverage for all.

Accounting practices vary not only across firms, but also across countries, reflecting the respective legal and cultural background. Attempts at harmonization therefore continue to be rebuffed. The purpose of this paper is to argue that different wordings in national laws, and different interpretations of similar wordings in national laws, can be explained by taking recourse to the philosophy of language, referring particularly to Searle and Wittgenstein.

The example of the substance over form principle, investigated in seven countries, is particularly suitable for this analysis. It is known in all accounting jurisdictions, but still has very different roots in different European countries, with European and international influences conflicting, which is reflected in the different wording of the principle from one country to the next, and the different socially constructed realities associated with those wordings.

This paper shows that, beyond accounting practices, the legal and cultural background of a country affects the wording of national law itself. The broad conclusion is that different socially constructed realities might tend to resist any attempt at harmonized socially constructed words.

The paper contributes to the debate surrounding the possible homogenization of accounting regulations, illustrating the theory of the social construction of both “reality” and “language” on the specific application of one common principle to various Member State environments.