Modern public internal control systems and accountability in health care organizations

The introduction of NPM principles changed the meaning and the contents of public sector accountability as it is no longer intended as a mere compliance with rules and procedures but as the need to give an account to the citizenry, in terms of how results are achieved and resources are used in their pursuit. Accountability for results requires the modernisation of traditional control systems. These check whether regulations are followed without ensuring that the achievement of objectives is controlled. Confirming the growing need in modernizing internal control systems and increasing managerial accountability and transparency in spending public money, the European Commission has developed a reference model for the public sector: Public Internal Financial Control – PIfC. The paper tries to contribute the relevant debate on the usefulness of internal control systems by exploring the implicit positive relationship between them and managerial accountability envisaged in the PIfC model. To this end the research focuses on a case study set in the context of Italian health care sector and in the main health care organization located in the Region of Sardinia.