Safeguarding accountability through internal auditing in the public sector. The Case of the Italian National Healthcare System

This study arises from the need to investigate how internal auditing contributes to accountability and transparency and, ultimately, how it creates value – defined as its ability to effectively communicate within the public sector. It focuses on healthcare as the primary area of study, given the sector’s reforms and innovations, which are now of interest to other public entities.

After reviewing the historical evolution of control theories in Public Administration, the study examines the development of legislation concerning control mechanisms in the healthcare sector, with particular attention to those ensuring accountability and transparency.

The Italian National Healthcare Service serves as a compelling case study within the diverse and complex public sector. Italy stands as a key example of an advanced European country, particularly in healthcare, which adopted managerial practices – such as internal auditing – earlier than many other sectors. From the introduction of managerial principles to subsequent reforms, including accounting harmonization, progressive corporatization has both necessitated and continues to drive greater accountability.

While transparency is valuable, it must evolve into accountability to ensure that resources, processes, and services are not only managed transparently but also efficiently and in alignment with the needs of the population. This shift is essential for maintaining public trust, improving the quality of care, and optimizing the use of public resources.