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  • 學位論文

醫療產業會計師選擇與財務報表品質之研究

Auditor Choice and Financial Report Quality in Hospital Industry

指導教授 : 林嬋娟

摘要


近年來,臺灣醫院之財務報告品質及董事會功能受到主管機關及外界關注之程度日益增加。為回應外界批評,醫療法人需向衛生福利部申報經董事會通過,且經會計師查核簽證之年度財務報告,再經衛生福利部聘請外部專家審查。衛生福利部並自2007年起公布醫療財團法人之財務報告及其審查意見,醫療社團法人則未公布。此外,中央健康保險署為遵循二代健保資訊公開之原則,自2013年起公開領有健保費用一定金額以上醫院,經會計師查核簽證之財務報告,以利外界課責。然而,現行主管機關對於不同型態之醫院財務報告,有不同之管理及揭露機制,其代理成本(監督成本)不同。據監察院2019年之調查報告指出,部分醫療財團法人之財務報告雖經會計師查核簽證,仍經衛生福利部發現諸多缺失,顯示部分醫院之財報品質及審計品質有待加強。再者,現行醫療法尚無對醫療法人董事會需具有獨立性,或需具有財務專長董事之規範。鑑於現行主管機關對於不同型態之醫院財務報告,有不同之監督機制,又董事會之有效性亦為醫院治理之重要因素,皆為可能影響醫院選擇會計師之因素,進而影響財務報告品質及審計品質,然目前尚乏足夠之實證研究作為政策修訂之基礎。因此,為了填補實證研究之不足,本研究探討臺灣醫院之組織型態及董事會組成,對其選擇會計師之關聯,並進一步探討會計師選擇對財務報告品質及審計品質之影響。實證結果顯示,醫療財團法人較醫療社團法人及私立醫療機構等營利醫院更可能選擇四大或產業專家會計師事務所之會計師,又外部財務專長董事比率越高,及內部醫療專長董事比率越高之醫療財團法人,較可能選擇四大會計師事務所之會計師。再者,選擇四大或產業專家會計師事務所會計師之私立醫療機構,提列較少之裁決性健保核減數,代表四大或產業專家會計師事務所抑制盈餘管理之程度較高。另選擇四大或產業專家會計師事務所之醫療財團法人,收到主管機關對於財報之審查意見較少,代表四大或產業專家會計師有較好之審計品質。本研究之發現,可供主管機關作為改善醫院財務報告監督機制及醫院管理制度之參考。

並列摘要


In recent years, the quality of financial reports in Taiwan’s hospital industry and the effectiveness of the board have received significant attention from regulators and the public. This study mainly aims to investigate whether hospital organization form and board characteristics affect auditor choice of hospitals in Taiwan. Furthermore, it examines the effect of auditor choice on audit quality. The results indicate that medical care foundations are more likely to choose Big N auditors and audit specialists compared to for-profit hospitals. In addition, I found that medical care foundations with more outside board directors and inside medical board members are more likely to choose a Big N auditor. Regarding the effects of auditor choice, the results suggest that private hospitals choosing Big N auditors and audit specialists are more likely to report less discretionary accruals of NHIA deduction. Moreover, I found that medical care foundations choosing Big N auditors and audit specialists are more likely to receive fewer comments from the review committee appointed by MHW. The research findings provide practical and policy implications for the regulator to consider revising the requirements of financial reports and governance of hospitals.

參考文獻


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