The The Auditor's Opinion in the Health Sector

Audit reports contain important information for decision-making, particularly in entities that use public resources, such as hospitals. The public health sector plays a significant role in the Portuguese economy, since 14% of its government's budget is allocated to the expenditure in that sector. This study aims to identify and characterize the qualifications and emphasis presented in the audit reports of Portuguese public hospitals (EPE hospitals) from 2018 to 2021. The definition of the sample and the data collection were supported by the SABI and ORBIS databases and the EPE hospitals' annual and audit reports. The results evidence that the auditor's opinion is qualified in most of the audit reports of EPE, which means it contains qualifications and/or emphasis. The dominant qualifications are associated with asset and investment items, while the main emphasis is related to equity, highlighting the uncertainties in economic and budgetary conditions related to COVID-19. Auditors of Big 4 firms did not sign any audit reports and only six percent were signed by women. This study offers theoretical and practical contributions. It expands knowledge on the auditor's qualified opinion in public hospitals, addressing a gap in the literature. Analyzing typical qualifications and emphases in audit reports identifies patterns for future studies and the most sensitive and risky areas to be considered by auditors. The results also contribute to managers and regulatory bodies improving the transparency and accountability of public hospitals, through a more efficient allocation of resources and the implementation of better internal control systems in public hospitals.