Internal Auditing in Italian National Healthcare Service. Evidence from two regional cases: Veneto and Emilia-Romagna

Journal title MECOSAN
Author/s Cecilia Langella, Ilaria Elisa Vannini, Milena Marciacano, Niccolò Persiani
Publishing Year 2023 Issue 2022/123
Language Italian Pages 21 P. 7-27 File size 0 KB
DOI 10.3280/mesa2022-123oa15580
DOI is like a bar code for intellectual property: to have more infomation click here

View article Download Open Access article

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

In the last decade, legislation on accounting harmonization and external audit readiness made public healthcare organizations devote increasing attention to the development of Internal Control Systems. Internal Auditing function (henceforth, IA) was frequently established and regarded as an opportunity to systematize and provide assurance upon the whole Internal Control System. This study is aimed at analyzing how the IA function has been implemented and developed in the Italian National Health Service. The empirical analysis relies on case study methodology and presents two of the most relevant experiences settled respectively in the Regional Health Services of Veneto and Emilia-Romagna. The study examines and compares: IA roles, types of audit, IA process, organizational variables, and internal auditors characteristics. Results show the existence of two distinct implementation modes, highly influenced by contextual factors, but also characterized by interesting similarities. These findings may provide a useful reference point for the establishment and implementation of the IA function in other regions.

Keywords: ; Internal Auditing; Internal Control Systems; Public healthcare organizations; Case studies; Veneto Region; Emilia-Romagna Region

  1. Abbott L.J., Daugherty B., Parker S., Peters G.F. (2016). Internal audit quality and financial reporting quality: the joint importance of independence and competence. Journal of Accounting Research, 54(1): 3-40. DOI: 10.1111/1475-679X.12099
  2. Allegrini M., D’Onza G. (2003). IA and risk assessment in large Italian companies: an empirical survey. International Journal of Auditing, 7(3): 191-208. DOI: 10.1046/j.1099-1123.2003.00070.x
  3. Anessi Pessina E., Cantù E., Persiani N. (2011). Armonizzazione contabile e revisione dei bilanci nelle aziende sanitarie pubbliche. In: Anessi Pessina E., Cantù E. (a cura di). L’Aziendalizzazione della Sanità in Italia. Rapporto OASI 2011. Milano: Egea.
  4. Arena M., Azzone G. (2007). Internal audit departments: adoption and characteristics in Italian companies. International Journal of Auditing, 11(2): 91-114. DOI: 10.1111/j.1099-1123.2007.00357.x
  5. Arena M., Azzone G. (2009). Identifying organizational drivers of internal audit effectiveness. International Journal of Auditing, 13(1): 43-60. DOI: 10.1111/j.1099-1123.2008.00392.x
  6. Berry A.J., Otley D.T. (2004). Case-based research in accounting. In: Humphrey C., Lee B. (a cura di). The Real Life Guide to Accounting Research, a Behind-The-Scenes View of Using Qualitative Research Methods. Amsterdam: Elsevier.
  7. Borsa Italiana (2018). Codice di Autodisciplina. -- https://www.borsaitaliana.it/comitato-corporate-governance/codice/2018clean.pdf.
  8. Braganti M., Persiani N. (a cura di) (2002). Il controllo di regolarità amministrativo-contabile sulle procedure delle aziende sanitarie ed ospedaliere. Milano: FrancoAngeli.
  9. Cantarelli P., Lega F., Longo F. (2017). La regione capogruppo sanitaria: assetti istituzionali e modelli organizzativi emergenti. In: Cergas Bocconi (a cura di). Rapporto OASI 2017. Milano: Egea.
  10. Cantù E. (2014). Il bilancio delle Aziende di Servizi Sanitari. Milano: Egea.
  11. Chiucchi M.S. (2012). Il metodo dello studio di caso nel management accounting. Torino: Giappichelli Editore.
  12. Chiucchi M.S. (2014). Il gap tra teoria e prassi nel Management Accounting: il contributo della field-based research. Management Control, 3: 5-9. DOI: 10.3280/MACO2014-003001
  13. Christopher J., Sarens G., Leung P. (2009). A critical analysis of the independence of the internal audit function: evidence from Australia. Accounting, Auditing & Accountability Journal, 22(2): 200-220. DOI: 10.1108/09513570910933942
  14. Comitato per la Corporate Governance (2018). Codice di autodisciplina, § 7.
  15. CoSO (2004). Enterprise Risk Management – Integrated Framework. Executive Summary, September. Committee of Sponsoring Organizations of the Treadway Commission. – https://www.coso.org/Documents/COSO-ERM-Executive-Summary.pdf.
  16. CoSO (2013). Internal Control – Integrated Framework. Executive Summary, May. Committee of Sponsoring Organizations of the Treadway Commission. – https://www.coso.org/Documents/990025P-Executive-Summary-final-may20.pdf.
  17. CoSO (2017). Enterprise Risk Management – Integrated Framework. – Aligning risk with strategy and performance. Committee of Sponsoring Organizations of the Treadway Commission. – https://www.coso.org/documents/2017-coso-erm-integrating-with-strategy-and-performance-executive-summary.pdf.
  18. Dittmeier C.A. (2011). Internal Auditing: Chiave per la corporate governance. Milano: Egea.
  19. Eisenhardt K.M. (1989). Building theories from case study research. Academy of Management Review, 14(4): 532-550. DOI: 10.5465/amr.1989.4308385
  20. Goodwin J., Yeoh T.Y. (2001). Two factors affecting internal audit independence and objectivity: evidence from Singapore. International Journal of Auditing, 5(2): 107-125. DOI: 10.1111/j.1099-1123.2001.00329.x
  21. Gramling A.A., Maletta M.J., Schneider A., Church B.K. (2004). The role of the internal audit function in corporate governance: A synthesis of the extant IA literature and directions for future research. Journal of Accounting Literature, 23(1): 194-244. -- https://www.proquest.com/scholarly-journals/role-internal-audit-function-corporate-governance/docview/216303617/se-2?accountid=9941.
  22. Hass S., Abdolmohammadi M.J., Burnaby P. (2006). The Americas literature review on IA. Managerial Auditing Journal, 21(8): 835-844. DOI: 10.1108/02686900610703778
  23. Institute of Internal Auditors (2013). IIA Position Paper: The Three Lines of Defense in Effective Risk Management and Control [Brochure]. Florida, USA: Altamonte Springs.
  24. Kotb A., Elbardan H., Halabi H. (2020). Mapping of internal audit research: a post-Enron structured literature review. Accounting, Auditing & Accountability Journal, 33(8): 1969-1996. DOI: 10.1108/AAAJ-07-2018-3581
  25. Langella C., Persiani N. (2022). Il sistema delle procedure amministrativo-contabili della GSA: il caso di Regione Lombardia e Regione Veneto. Mecosan 122: 59-84. DOI: 10.3280/mesa2022-122oa14618
  26. Liu J., Woo H., Boakye-Bonsu V. (1997). Developing IA procedures using a benchmarking approach. Managerial Auditing Journal, 12(9): 464-78. DOI: 10.1108/02686909710185198
  27. Luburic R., Perovic M., Sekulovic R. (2015). Quality Management in Terms of Strengthening the “Three Lines of Defence” in Risk Management – Process Approach. International Journal for Quality Research, 9(2): 243-250.
  28. Marchi L. (2019). Revisione aziendale e sistemi di controllo interno. Milano: Giuffrè Francis Lefebvre.
  29. Mihret D.G., Grant B. (2017). The role of IA in corporate governance: a Foucauldian analysis. Accounting, Auditing & Accountability Journal, 30(3): 699-719. DOI: 10.1108/AAAJ-10-2012-1134
  30. Nerantzidis M., Pazarskis M., Drogalas G., Galanis S. (2020). IA in the public sector: a systematic literature review and future research agenda. Journal of Public Budgeting , Accounting & Financial Management, ahead-of-print. DOI: 10.1108/JPBAFM-02-2020-0015
  31. Parker L.D. (2012). Qualitative management accounting research: assessing deliverables and relevance. Critical Perspectives on Accounting, 23(1): 54-70. DOI: 10.1016/j.cpa.2011.06.002
  32. Persiani N. (2008). Principi contabili e di controllo interno per le aziende sanitarie ed ospedaliere. Milano: FrancoAngeli.
  33. Persiani N. (2012). Il controllo contabile del bilancio degli enti del S.s.n.: verso la certificabilità dei dati e dei bilanci. Ragiusan, 344: 28-36.
  34. Persiani N., Bonin M. (2018). La gestione della spesa sanitaria accentrata tramite holding: il caso Veneto di Azienda Zero. In: Anessi Pessina E. (a cura di). L’armonizzazione contabile nel settore pubblico italiano. Implicazioni per le regioni e per i servizi sanitari regionali. Milano: FrancoAngeli.
  35. Roussy M. (2013). Internal auditors’ roles: From watchdogs to helpers and protectors of the top manager. Critical Perspectives on Accounting, 24(7-8): 550-571. DOI: 10.1016/j.cpa.2013.08.004
  36. Roussy M., Perron A. (2018). New Perspectives in Internal Audit Research: A Structured Literature Review. Account Perspectives, 17(3): 345-385. DOI: 10.1111/1911-3838.12180
  37. Ryan B., Scapens R.W., Theobald M. (a cura di) (2002). Research method and methodology in finance and accounting (2nd Ed.). London: Thomson Learning.
  38. Stewart J., Subramaniam N. (2010). Internal audit independence and objectivity: emerging research opportunities. Managerial Auditing Journal, 25(4): 328-360. DOI: 10.1108/02686901011034162
  39. Woods M. (2011). Risk Management in Organizations: An Integrated case study approach. New York, USA: Routledge.
  40. Yin R.K. (2003). Case study research: Design and methods (3rd Ed.). Thousand Oaks: Sage.
  41. Yin R.K. (2012). Applications of case study research (3rd Ed.). Washington D.C.: Sage.

  • Esperienze applicative e implicazioni manageriali per l'Internal Audit nel SSN: Il workshop Control Risk Self Assessment e i successivi sviluppi per il Sistema di Controllo Interno Cecilia Langella, Ilaria Elisa Vannini, Rosanna D'Amore, Niccolò Persiani, in MECOSAN 132/2025 pp.7
    DOI: 10.3280/mesa2024-132oa20676
  • Se pretendi di avere tutto sotto controllo significa che non stai andando abbastanza veloce: l'esperienza dell'Audit sulle prestazioni in regime di Libera Professione nella Regione Veneto Elena Cantù, Michela Castellan, Enrico De Gaspari, Monica Gennari, Cecilia Langella, Isabella Ruzza, Roberto Tiffi, in MECOSAN 128/2024 pp.161
    DOI: 10.3280/mesa2023-128oa18597

Cecilia Langella, Ilaria Elisa Vannini, Milena Marciacano, Niccolò Persiani, L’Internal Auditing nel Servizio Sanitario Nazionale: l’esperienza della Regione Veneto e della Regione Emilia-Romagna in "MECOSAN" 123/2022, pp 7-27, DOI: 10.3280/mesa2022-123oa15580