Internal Audit in Public Hospitals: the case of Greece
DOI:
https://doi.org/10.15291/oec.4220Keywords:
Internal Audit, Public Sector, Greek Public Hospitals, Regulatory Framework, Governance PracticesAbstract
Internal control is of utmost importance for effective corporate governance, particularly in public hospitals aiming for modernization in the Greek framework. Internal audit functions enhance transparency, enforce accountability, and ensure compliance with societal values, bolstering public trust. This study delves into the implementation of internal control in Greek public hospitals, considering factors like size, structure, and operational intricacies. We explore the regulatory framework, procedures, scope, and objectives, while interviewing auditing experts for insights into challenges and opportunities. Findings reveal procedural dominance in current implementation of the Law. Focus on accounting neglects crucial functional departments. The audit committee's role and composition raise independence concerns. Understaffing further hampers operations. A significant weakness appears in the independence of the audit. Internal auditors report to the hospital administrator and participate in the audit committee. The appointment and remuneration of auditors is not based on the auditor's competence and suitability, but on a cost basis. The question therefore arises as to whether the auditor performs the duties objectively and impartially in accordance with the International Institute of Internal Auditors' standards. Furthermore, regarding the research question on the role of the internal auditor and the treatment by auditees, there has been a significant improvement as evident by the respondents’ answers.
References
Adeniji, A. A., (2004), “Auditing and investigations”. Value Analysis Consult (Publishers).
Asare, T., (2009), “Internal auditing in the public sector. Promoting good governance and performance improvement”, International Journal on Governmental Financial Management, Volume 9, Issue 1, pp. 15-28.
Barber, S. L., Borowitz, M., Bekedam, H., Ma, J., (2014), “The hospital of the future in China: China's reform of public hospitals and trends from industrialized countries”, Health policy and planning, 29 (3), 367-378.
Barker, E., (1999), “Organization and Management Accounting”, Hill Book Company Inc. New York, P60.
Chambers, A. D., Odar, M., (2015), “A new vision for internal audit”, Managerial Auditing Journal, Volume 30, Issue 1.
Collins A., (1904), “A Municipal Internal Audit”, Gee & Co., London HB, [later revised editions in 1913, 1922, 1931 and 1934] pp. 142.
Commonwealth of Australia, (2008), “Better Practice Guide - Risk Management”, Australian Government, Comcover, available at http://www.finance.gov.au/comcover/better-practice-guide.html.
Diamond J., (2002), “The Role of Internal Audit in Government Financial Management: An International Perspective”, IMF Working Paper No. 02/94.
Eulerich A., Eulerich M., (2020), “What is the value of internal auditing? - A literature review on qualitative and quantitative perspectives”, Maandblad Voor Accountancy en Bedrijfseconomie, pp. 1-4, 6-8.
Enofe A.O., Mgbame C.J., Osa-Erhabor V.E. Ehiorobo A.J., (2013), “The Role of Internal Audit in Effective Management in Public Sector”, Research Journal of Finance and Accounting, 4 (6): pp. 162-168.
Goodwin-Stewart J., Kent P., (2006), “The Use of Internal Audit by Australian Companies”, Managerial Auditing Journal, Vol. 21, No. 1, pp. 81-101.
Hellenic Institute of Internal Auditors, (2008), "The professional application framework", Private Edition.
Jeppesen K.K., (2012), “Jurisdictional competition between private and public sector auditors: The case of the Danish Certified Public Sector Auditor Qualification”, Financial Accountability and Management, 28(2), 215–246.
Jeppesen K.K., Carrington T., Catasús B., Johnsen Å., Reichborn-Kjennerud K., Vakkuri J., (2017), “The strategic options of supreme audit institutions: The case of four Nordic countries”, Financial Accountability & Management, 32(2), 146–170.
Johnsen A., (2019), "Public sector audit in contemporary society: A short review and introduction", Financial Accountability and Management, 35(2), 121-127.
Johnson I.E., (1996), “Solving Public Sector Management Accounting Problems”, Star Press Lagos pp.15.
Koutoupis A., Rodakos A.H., (2021), "Why internal audit failed in the public sector, what needs to change", Retrieved from www.euro2day.gr.
Kremalis D., (2013), "The internal audit of hospitals", Health Review, Volume 24, Issue 142.
Mattei G., Grossi G., Guthrie J., (2021), “Exploring past, present and future trends in public sector auditing research: a literature review”, Meditari Accountancy Research, Vol. 29, Issue 7.
Meigs W. B., (1951), “The Expanding Field of Internal Auditing”, The Accounting Review, Vol.26, No.4, October, pp. 518-523.
Meriam D., Najat M., Karima S., (2017), “The new practices of the public management in Morocco: The use of the internal audit”, International Journal of Economics, Commerce and Management, Volume 5, Issue 3, Page 333-338.
Mikkers M., Sauter W., Vincke P., Boertjens J., (2017), “Healthcare Fraud, Corruption and Waste in Europe, National and Academic Perspectives”, Eleven International Publishing.
Morgan D., Astofli R., (2013), “Health Spending Growth at Zero: Which Countries, Which Sectors Are Most Affected”, OECD Health Working Paper No.60.
National Center for Public Administration and Self-Government, (2018), "Internal Audit as a Policy Tool in the Public Sector", Innovative Workshop, Retrieved from www.ekdd.gr.
National Transparency Authority, (2021), "Inventory of Procedures of the Internal Control System of Financial Management", Retrieved from www.aead.gr.
OECD, (2018), "Internal Audit Handbook for Greek Public Administration", OECD Publishing, Paris.
Owler L. & Βrown J.L., (1999), “Cost and Management Accounting Methods”, Macdonald & Evans Press London, pp. 39.
Papastathis P., (2003), "Modern internal control in business organizations and its practical application", Private Edition.
Papastathis P., (2014), "Modern internal control and its practical application", Private Edition.
Pelekanakis G., (2015), "Viewpoint: Internal control mirroring business", Retrieved from www.kathimerini.gr.
Ministry of Health, (2011), "Model Hospital Procedures: financial department, "Internal Audit", Retrieved from www.moh.gov.gr.
Revanoglou A., (2013), "Internal audit in Greek hospitals", Health Review, Volume 24, Issue 140.
Revanoglou A., (2013), "The finances of hospitals- A different approach", Health Review, Volume 24, Issue 142.
Revanoglou A., (2015), "Internal Audit in Public Health Institutions (Hospitals)", Hellenic Institute of Internal Auditors, Retrieved from www.hiia.gr.
Rodakos, A. I., Koutoupis, A. G., Thysiadou, A., Kampouris, C. (2021), “A systematic literature review on the implementation of internal audit in European and non-European public hospitals [Special issue]”. Journal of Governance & Regulation, 10(4), 336–342.
Tabish, S. A. (2012), “Healthcare: from good to exceptional governance”, JIMSA, 25(3), 147-150.
Tracey J., (1994), “Fundamentals of Financial Accounting”, John curly and sons Inc. New York, pp. 17.
Troupin, S., Put, V., Weets, K., Bouckaert, G., (2010). “Public audit systems: from trends to choices”. In 6th Transatlantic Dialogue Conference, pp. 24-26.
Unegbu, A. O., Kida, M. I. (2011). “Effectiveness of internal audit as instrument of improving public Sector management”. Journal of emerging trends in economics and management sciences, 2(4), 304-309.
Unegbu, A. O., Obi, B. C. (2007). “Auditing”. Hipuks Additional Press Uwani Enugu, Nigeria, pp. 7.
Zulkifli Baharud-din, Alagan Shokiyah, and Mohd Serjana Ibrahim, (2014), “Factors that Contribute to the Effectiveness of Internal Audit in Public Sector”, International Proceedings of Economics Development and Research, 70, 126.
Law 3429/2005, "Public Enterprises and Organizations (D.E.K.O.)", Government Gazette 314/A/27-12-2005.
Law 3492/2006, "Organization of the control system to ensure sound financial management of the State Budget and the entities within the State Budget and other provisions", Government Gazette 210/A/5-10-2006.
Law 4025/2011, "Reconstruction of Social Solidarity Bodies, Rehabilitation Centres, Restructuring of the Social Security System and other provisions", Government Gazette 228/A/2-11-2011.
Law 4622/2019, "Executive State: organization, operation and transparency of the Government, governmental institutions and central public administration", Government Gazette 133/A/7-8-2019.
Law 4795/2021, "Public Sector Internal Audit System, Integrity Advisor in the Public Administration and other provisions on public administration and local government", Government Gazette 62/A/17-4-2021.


