From Environmental Financial Literacy to Sustainable Healthcare: The Mediating Role of Governance and Environmental, Social, and Governance Reporting

Background/Objectives: Healthcare organizations face challenges in integrating environmental sustainability with financial constraints, digitalization, governance, and social responsibilities. Although financial and digital financial literacy have been associated with environmental, social, and governance (ESG) performance, the organizational mechanisms underlying these relationships remain insufficiently understood. This study examines Environmental Financial Literacy (EFL) as a sustainability-relevant decision-making capability and Governance/ESG Reporting as a potential mediator linking EFL with environmental and social sustainability. Methods: A quantitative, cross-sectional survey included 1415 healthcare employees in Serbia. Exploratory factor analysis assessed the measurement structure, followed by reliability and validity testing. Covariance-based structural equation modeling (CB-SEM) examined the hypothesized relationships, while bias-corrected bootstrapping assessed indirect effects. Results: Four distinct constructs were identified. EFL was positively associated with Governance/ESG Reporting (β = 0.658, p < 0.001), which was positively associated with Environmental Sustainability (β = 0.561, p < 0.001) and Social Sustainability (β = 0.469, p < 0.001). Governance/ESG Reporting partially mediated both relationships, with significant indirect effects on Environmental Sustainability (β = 0.369, 95% CI [0.330, 0.415]) and Social Sustainability (β = 0.369, 95% confidence interval (CI) [0.330, 0.415]). Both indirect effects exceeded the corresponding direct effects. Conclusions: Governance/ESG Reporting represents a significant statistical intermediary between EFL and organizational sustainability. The findings highlight the potential importance of integrating sustainability-relevant financial competence with governance and reporting practices in healthcare organizations, while offering a framework for further investigation across different healthcare systems.