Factors affecting the implementation of responsibility accounting in public hospitals: Empirical evidence from Vietnam

Amid ongoing financial reforms and increasing autonomy among public service units in Vietnam, the implementation of Responsibility Accounting (RA) in public hospitals has become a critical mechanism for enhancing financial efficiency, managerial accountability, and overall service quality. However, in practice, the adoption of RA remains limited and fragmented. This study aims to investigate the key determinants influencing the application of RA in Vietnamese public hospitals. Drawing on a comprehensive theoretical foundation Agency Theory, Contingency Theory, Diffusion of Innovations Theory, and Fayol’s Management Theory the proposed research model incorporates eight independent variables: management decentralization, unit size, financial management characteristics, level of information technology adoption, managerial and accounting qualifications and awareness, legal environment, and financial autonomy. A mixed-method research design was adopted, and empirical data were gathered through 257 valid survey responses from public hospitals across the country. Linear regression analysis indicated that the majority of these factors significantly affect RA implementation, with financial management characteristics, decentralization, and financial autonomy emerging as the most influential predictors. The study contributes to both theory and practice by providing empirical evidence on the institutional and organizational factors that facilitate RA adoption. Furthermore, it offers actionable policy recommendations to strengthen the strategic integration of RA within the public healthcare sector in Vietnam.