Determinants of Qualified Audit Opinion: Empirical Study of Portuguese Private Sector Hospitals

This study aims to identify the determinants of the auditor’s qualified opinion in 71 Portuguese privately owned hospitals from 2019 to 2021. Seven research hypotheses are defined, related to the characteristics of the audited hospitals (size, performance, and debt), the qualified opinion of the previous year and the auditor’s characteristics (type, gender, and switching). The hypotheses are statistically tested using logistic regression models and data collected from the ORBIS and SABI databases, as well as the hospital’s annual reports. The results evidence that the determinants of the qualified opinion in private sector hospitals are the qualified opinion from the previous year, the hospital’s debt level, and its performance. The first two factors have a positive influence, while performance has a negative influence. In turn, the size of the hospital and the characteristics of the auditor do not seem to influence that opinion. In the private health sector, it seems that the endogenous characteristics of the audited hospital have the most influence on the auditor’s opinion, while other factors, such as the auditor’s characteristics, do not appear to influence qualified opinion. The present study provides important contributions to theory and practice, as the qualified opinion is highly significant for more informed decision making and research related to audit opinion in the healthcare sector is very scarce.