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This paper aims to contribute to the debate over the desirability of introducing an accrual-based accounting system in the public sector by examining whether accrual-based accounting information is superior to cash-based information in the context of public sector entities.

This paper applies a quantitative research method to assess the degree of smoothness and relevance of the accrual components of income recorded by 302 entities of the Italian National Health Service (INHS) over the period 2014–2020.

The analysis reveals that net income is smoother than cash flows as a summary measure of economic results and that accounting for accruals improves the predictability of future cash flows. However, the authors' novel disaggregation of accrual accounts reveals that those accounts that contribute the most to making income smoother than cash flows – noncurrent assets and liabilities – are also those that contribute the least to predicting future cash flows.

The disaggregation of accrual accounts allows to identify the sources of the informational benefits of accrual accounting, and to document the existence of an informational “trade-off” between smoothness and relevance in the context of public sector entities.

This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the equity of the whole financing system.

Lorenz dominance analysis and Kakwani progressivity index were applied on data from 2010/2011 Household Income, Expenditure, and Consumption Survey and the National Health Accounts 2011 using Stata to evaluate the progressivity of each source of health-care finance and the financing system overall.

The data show that Egypt’s health-care system, which is largely financed by out-of-pocket (OOP) payments, is slightly regressive, with an overall Kakwani index of −0.079. The overall regressive effect was the result of three regressive sources (OOP payments, an earmarked cigarette tax and direct taxes), one proportional finance source (social health insurance) and two slightly progressive sources (indirect taxes and private health insurance). This shows that the burden of financing health care falls more on the poor. These results signal the need for reform of health-care financing in Egypt to reduce dependence on OOP payments to achieve more equitable financing.

The paper seeks to augment the literature on health-care financing in Egypt by calculating specific progressivity estimates for all five sources of financing the Egyptian health-care system and analyzing the overall equity of this financing system. It will, therefore, provide a benchmark for monitoring the equity of finance in the Egyptian health-care system in future studies and allow one to assess the impact of implemented financing reforms in the future on the level of progressivity of health system financing.

The present study aims to extend the knowledge of intellectual capital disclosure (ICD) disclosure practices in the Italian Healthcare Organisations (HCOs) context. The ultimate goal of the study is to provide fresh insight into the possible explanatory factors that may drive the extent of ICD provided by Italian HCOs via the web.

The present study applies a manual content analysis on the websites of a sample of 158 HCOs to determine the level of voluntary ICD. A multivariate regression model is estimated to test the association between different variables – size, gender diversity in top governance positions, financial performance and indebtedness – and the level of ICD provided by sampled HCOs through their official websites.

Content analysis results reveal that – in the absence of mandatory requirements – Italian HCOs tend to use websites to disclose information about IC. Particular attention is devoted to Structural and Relational Capital. The statistical analysis pinpoints that size and indebtedness negatively influence the level of ICD. In contrast, the presence of a female General Manager (GM) positively drives ICD. Also, it is observed that Research and University HCOs and those located in the Italian Northern Regions are particularly prone to discharge accountability on IC through websites.

To the best of the authors’ knowledge, this is the first study that examines voluntary ICD practices through websites in the Italian HCOs' context. Also, since prior studies on IC in the healthcare context are mainly descriptive or normative, this is the first study examining the potential determinants of ICD provided by HCOs in terms of size, gender diversity in top governance positions, financial performance and indebtedness.

Climate change affects the geographic and seasonal range of malaria incidence, especially, in poor tropical countries. This paper aims to attempt to conceptualize the potential economic repercussions of such effects with its focus on Ethiopia.

The paper is conceptual and descriptive in its design. It first reviews existing literature and evidence on the economic burdens of malaria, and the impacts of climate change on malaria disease. It then draws the economic implications of the expected malaria risk under the future climate. This is accompanied by a discussion on a set of methods that can be used to quantify the economic effects of malaria with or without climate change.

A review of available evidence shows that climate change is likely to increase the geographic and seasonal range of malaria incidence in Ethiopia. The economic consequences of even a marginal increase in malaria risk will be substantial as one considers the projected impacts of climate change through other channels, the current population exposed to malaria risk and the country’s health system, economic structure and level of investment. The potential effects have the potency to require more household and public spending for health, to perpetuate poverty and inequality and to strain agricultural and regional development.

This paper sheds light on the economic implications of climate change impacts on malaria, particularly, in Agrarian countries laying in the tropics. It illustrates how such impacts will interact with other impact channels of climate change, and thus evolve to influence the macro-economy. The paper also proposes a set of methods that can be used to quantify the potential economic effects of malaria. The paper seeks to stimulate future research on this important topic which rather has been neglected.

Since the 1980s, governments worldwide have been implementing the move from cash to accrual accounting. Scholars initially considered the appropriateness of this accounting reform to be self-evident, but later they have expressed critical views. This paper systematises the existing literature intending to reflect on the adverse effects of adopting accrual accounting in the public sector and identify implications for future research.

The present study builds on a systematic literature review of 106 academic articles published between 1980 and 2021. It is based on the “preferred reporting items for systematic reviews and meta-analyses” (PRISMA) method. Synthesising research through a transparent, rigorous and replicable process makes it possible to identify and discuss the adverse effects of adopting public sector accrual accounting.

Significant issues are linked to organisational impacts and accountability. Resistance to change is the main negative consequence and is more likely in countries that have chosen to adopt accrual accounting without maintaining cash accounting. The new accounting rules make accounting information more complex and arbitrary for citizens and politicians. How these criticalities should be addressed deserves further investigation.

This paper offers a comprehensive literature review on the drawbacks of adopting accrual accounting in the public sector. It could provide a general lesson to be applied to policymakers of other jurisdictions currently considering this transition to prevent the adverse effects and act proactively.

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.

This paper examines the contested value of healthy life and wellbeing in a context of severe austerity, exploring how the value of “Public Health” is constructed through and with material-discursive practices and accounting representations. It seeks to explore the political and ethical implications of constructing the valuable through a shared consensus over the “facts” when addressing complex, multi-agency problems with long time horizons and outcomes that are not always easily quantifiable.

The theorisation, drawing on science and technology studies (STS) scholars and Karen Barad's (2007) agential realism, opens up the analysis to the performativity of both material and discursive practices in the period following a major re-organisation of activity. The study investigates two case authorities in England and the national regulator through interviews, observations and documentary analysis.

The paper demonstrates the deeply ethical and political entanglements of accounting representations as objectivity, consensus and collective action are constructed and resisted in practice. It goes on to demonstrate the practical challenges of constructing “alternative accounts” and “intelligent accountabilities” through times of austerity towards a shared sense of public value and suggests austerity measures make such aims both more challenging and all the more essential.

Few studies in the accounting literature have explored the full complexity of valuation practices in non-market settings, particularly in a public sector context; this paper, therefore, extends familiar conceptual vocabulary of STS inspired research to further explore how value(s), ethics and identity all play a crucial role in making things valuable.

This article analyzes the cognitive microfoundations, conflicting institutional logics and professional hybridization in a case characterized by conflict.

In contrast to the majority of earlier studies focusing on special health care, the study was conducted in a Finnish basic health care organization. The empirical data include 36 interviews, accounting reports, budgets, newspaper articles and meeting notes collected 2013–2018.

The use of accounting techniques in this case did not offer professionals sufficient support under conditions of conflict. The authors suggest that this perceived lack of support intensified the negative emotions toward accounting techniques. These negative emotions aggregated into incompatible professional-level institutional logics, which contributed to the lack of hybridization between such logics. The authors highlight the importance of the cognitive microfoundations, that is, the individual-level interpretations and emotional responses, in the analysis of conflicting institutional logics.

Managerial attention needs to be directed to accounting practices perceived as frustrating or threatening, a perception that can prevent the use of accounting techniques in the creation of professional hybrids. The Finnish basic health care context involves inconsistent political decision-making, multiple tasks, three institutional logics and individual interpretations and emotions in various decision-making situations.

This study develops microfoundational accounting research by illustrating how individual-level cognitive microfoundations such as dissatisfaction with budgeting, aggregate into professional-level institutional logics, and in our case, prevent professional hybridization in a basic health care setting characterized by conflict and three separate institutional logics.

A range of strategies to improve pharmaceutical care has been implemented by population health management (PHM) initiatives. However, which strategies generate the desired outcomes is largely unknown. The purpose of this paper is to identify guiding principles underlying collaborative strategies to improve pharmaceutical care and the contextual factors and mechanisms through which these principles operate.

The evaluation was informed by a realist methodology examining the links between PHM strategies, their outcomes and the contexts and mechanisms by which these strategies operate. Guiding principles were identified by grouping context-specific strategies with specific outcomes.

In total, ten guiding principles were identified: create agreement and commitment based on a long-term vision; foster cooperation and representation at the board level; use layered governance structures; create awareness at all levels; enable interpersonal links at all levels; create learning environments; organize shared responsibility; adjust financial strategies to market contexts; organize mutual gains; and align regional agreements with national policies and regulations. Contextual factors such as shared savings influenced the effectiveness of the guiding principles. Mechanisms by which these guiding principles operate were, for instance, fostering trust and creating a shared sense of the problem.

The guiding principles highlight how collaboration can be stimulated to improve pharmaceutical care while taking into account local constraints and possibilities. The interdependency of these principles necessitates effectuating them together in order to realize the best possible improvements and outcomes.

This is the first study using a realist approach to understand the guiding principles underlying collaboration to improve pharmaceutical care.

The present study aims to contribute to the growing stream of literature about the network perspective of value co-creation via key account management (KAM) by exploring how firms, in complex industrial markets, use key account strategies to create value, not only for buyers and sellers of industrial products/services but also, more widely, for larger ecosystems of stakeholders. The research question this paper seeks to address is how the KAM approach promotes value co-creation in multi-stakeholder ecosystem.

To answer this research question, this study uses a qualitative research approach based on data triangulation. This study focuses on the market access (MA) strategies implemented by a multinational UK-based pharmaceutical company within the Italian multi-stakeholder health-care ecosystem over several years.

The results show that KAM in complex networks acts as a catalyst for value creation, through multiple interactions with different actors and an ad hoc configuration of five strategic levers: product performance, economic impact, institutional relationships, commercial organization and communication. These levers are able to unlock the appropriate value drivers and form a specific “market access mix” implemented by the firm to both promote the adoption of the firm’s products and generate value for all market stakeholders.

The study offers an innovative and comprehensive evidence-based model for designing specific MA strategies aimed at co-creating value within multi-stakeholder ecosystems. The proposed MA mix outlines the fact that knowledge, relationships and innovation are not unique factors that can be leveraged by stakeholders to co-create value.