Accounting to ensure healthy lives: critical perspective from the Italian National Healthcare System

• DOI: https://doi.org/10.1108/CG-03-2019-0109
• Pages: 445-460
• Date: 03 March 2020
• Published date: 03 March 2020
• Author: Simone Pizzi,Fabio Caputo,Andrea Venturelli
• Subject Matter: Corporate governance,Strategy

Accounting to ensure healthy lives: critical

perspective from the Italian National

Healthcare System

Simone Pizzi, Fabio Caputo and Andrea Venturelli

Abstract

Purpose –The aim of the paper is to understand the differencesbetween ‘‘talking’’ and ‘‘walking’’ about

sustainabledevelopment goals (SDGs) in state-ownedenterprises (SOEs). Specifically,the authors have

conductedan analysis on 202 entities that operate within the Italian NationalHealthcare System (INHS) to

evaluatethe overall degree of transparency in termof contribution to the SDG3.

Design/methodology/approach –The research evaluatesthe degree of contribution to SDG3 by INHS

through the adoption of the theoretical framework proposed by Beck et al. (2010). Specifically, the

authorsassess the degree of contribution to this goalusing an interpretive content analysis thatcombines

the theoretical frameworkwith the 13 targets that composed the SDG3. For the authors’ purposes, they

analyze all INHS’s websiteto evaluate the presence/absence of social reportsproduced in the periods

2015-2018.

Findings –Although the great contribution to the SDG3, the INHS is characterized by a low degree of

accountability.In fact, only 12.21 per cent of INHS’s entitiesdisclosed at least one social report during the

observed period. Moreover, the authors’ results denote how the approach of INHS’s entities to social

reportingis different both in term of ‘‘quality’’ and ‘‘quantity.’’

Research limitations/implications –The SOEs play a central rolewithin the Agenda 2030 strategies.

However, public managers are less oriented than private managers to adopt non-financial reporting

tools. Furthermore,the authors’ results highlight the existence of asymmetric informationbetween SOEs

and citizens even if in presenceof best practices such as the INHS. In this sense, the adoption of non-

financial reports tool to engage in a more effective way with citizens could be a strategic driver for the

achievementof highest degree of social legitimacyto operate.

Practical implications –The paper is of use to publicmanagers operating in countries characterizedby

a high level of contribution to SDGs. Specifically, the authors’ results suggest how the adoption of

reportingtools could impact positively in terms of stakeholder’sawareness to SDG themes.

Originality/value –This paper contributes to the understanding of the central role covered by

academics,practitioners and public sectors to SDGs throughthe adoption of social reporting tools.

Keywords Public sector, Health-services sector, Accounting, Sustainable Development Goals (SDGs)

Paper type Research paper

1. Introduction

During the past years, the social role of the companies changed considerably because of

the global financial crisis and the specific attention paid by the regulators concerning their

social responsibility activities. The United Nations (UN) focused on these topics in its

Agenda 2030 through the definitionof 17 sustainable development goals (SDGs).

The SDGs consists of 17 goals and 169 targets to favor the achievement before 2030 of a

higher level of sustainability into the world (Mukhi and Quental, 2019;Ricciardelli et al.,

2018). The full achievement of these goals needs support by other entities such as public

sectors firms and NGOs (Bebbington and Unerman, 2018). In particular, a central role is

Simone Pizzi, Fabio Caputo

and Andrea Venturelli are

all based at the Department

of Economics, Universita

del Salento, Lecce, Italy.

Received 29 March 2019

Revised 3 October 2019

1 November 2019

26 November 2019

7 January 2020

16 January 2020

Accepted 5 February 2020

DOI 10.1108/CG-03-2019-0109 VOL. 20 NO. 3 2020, pp. 445-460, ©Emerald Publishing Limited, ISSN 1472-0701 jCORPORATE GOVERNANCE jPAGE 445

covered by public sector. However, prior analysis denoted how the introduction of SDGs

was characterized by several criticisms. In particular, some studies have highlighted the

attitude of the manager to disclose non-financial information without a real organizational

change (Mhlanga et al.,2019). In this sense, another problem is represented by the low

adoption of social reports by public firms that operate in a context characterized by high

expenses in public services connected to SDGs such as education, public health and

public security.

The Italian context is a typical example of a country with a high level of investment in public

services. Particularly, one of the most supported sectors in Italy is represented by the Italian

National Healthcare System (INHS). In fact, the health expenditure made by the Italian

Government consists of an average expense of 140bn of euro a year (European

Commission, 2016), and the entire healthcare system represents about the 75 per cent of

the total (ISTAT, 2017). These expenses are driven by several factors that define the Italian

context such as the provisions of free access for medical services, free drug distribution

and the free access to all services.

According to this evidence, the role of the Italian public sector is relevant to the

achievement of the SDG3 “Ensure healthy lives and promote well-being for all at all

ages.” Since 2007, the Italian context was characterized by a quick increase in

terms of SDG3 achievement and by a partially achievement of some targets because

of the improvement of the results connected to the reduction of death rates,

accidents and caesarean sections (ASVIS, 2018). However, even if in the presence

of these results, the INHS is characterized by disapprovals such as an inconsistent

per capita expense, long waiting lists and geographical, social inequality in terms of

access to the services and lack of transparency (Berta et al., 2016;OECD, 2017)

This evidence, as denoted in prior studies about social reporting in the public

sector, can be reconducted to public sector’s preference to engage with internal

stakeholders (Farneti and Guthrie, 2009). In this sense, the Italian citizens do not

perceive the quality of the services and the subsequentially contribution by the INHS

to SDG3.

The purpose of this paper is to contribute to the currentdebate about social reporting in the

public sector (Fusco and Ricci, 2019;Monfardini et al., 2013).Our analysis regards the

specific field of study about SDG’s reportingthat represents unexplored research areas that

needs contribution by management and accounting academics (Bebbington and Unerman,

2018;Buhmann et al.,2019). Moreover, our research will respond to the academics’

exigence to extend knowledge about SDGs implementation through specific insights and

lessons from different countries (Pineda-Escobar, 2019). Specifically, our paper will

respond to the following five questions:

Q1. Who discloses non-financialinformation in INHS?

Q2. What are the reasons behindthe adoption of non-financial reports by INHS’s entities?

Q3. How the INHS’s disclose theirnon-financial information?

Q4. What is the accountability’sdegree of the non-financial information relatedto SDG3?

Q5. What are the determinantsthat impact on entities SDG’s score?

Q6. Could social reports represent an effective driver to reduceasymmetric information

between INHS and citizens?

The paper is organized into five sections. After the introduction, Section 2 describes the

peculiarities of social accounting in public sector with specific attention to healthcare

systems, Section 3 illustrates the research and sampling methods, Section 4 presents

the results and the relative discussion while the Section 5 has our conclusions about the

study.

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