financial transaction cycle of the accrual accounting system, our findings, based on a sample of54 public hospitals, indicate that the adoption rate (83%) of accruals is quite satisfactory.However, the adoption rate (18.5%) of the accrual based cost accounting system has not yetseriously progressed 6 years after the declared NHS accounting reform (P.D. 146/03),despitethe steep rise in the cost of providing healthcare services in Greece during the last ten years andthe pressure to identify the causes of this increase. The highest ranked reasons for non-adoptionof ABAS are: the absence of an enforcement system by the state, the lack of adequate resourcesto support the implementation process of accruals, the current health sector reimbursementsystem whichresults in deviations between the true cost of services and price (provoking hugedeficits to the public health sector), and last but not least the complexity and high cost of runningtwo accounting systems in parallel, resulting in matching problems between them.Furthermore, the present study investigates the accrual accounting benefits and drawbacksderived from accrual accounting system implementation. More specifically, the majority of therespondents agree that the ABAS is useful in producing adequate information regarding theoverall financial picture to users and stakeholders, the evaluation of hospital performance, thereal level of liabilities, the determination of the full costs of services delivered, improvement inhospital fixed assets management and the decision making process.On the other hand, according to our survey results, a number of difficulties have been identifiedin the implementation of ABAS of which the most important are the adequacy of resources, thepersonnel’s shortage of knowledge on accrual accounting principles and standards, thepersonnel’s resistance to change, the lack of adequate training and the absence of financialincentives for the adoption of accrual basis accounting.Moreover, regarding the relationship amongst satisfaction and accounting benefits, problems,accrual implementation cost, years of accrual accounting adoption, education level of accountingstaff and hospital size our findings reveal that Greek public healthcare entities are more likely toexhibit higher satisfaction levels with accruals if they are of a significant size, employaccounting staff of a higher educational level, encountered fewer obstacles and problems duringimplementation and have a general perception that accruals brings substantial benefits to ahealthcare entity organization without a high cost.The healthcare entities with long-term experience in accrual accounting were not found to haveany significant impact on satisfaction level, maybe due to time fluctuations.
