Summary of hypothesis testing.

The aim of this study was to examine the relationship between internal control, financial accountability, and financial performance in the private healthcare sector in the Kingdom of Saudi Arabia (KSA) through a questionnaire survey of 78 private hospitals. Drawing on agency theory, the study utilized structural equation modelling with partial least-squares technique to test multiple hypotheses. Results indicate a significant positive relationship between internal control and financial performance, with financial accountability acting as a mediator. Additionally, financial accountability was found to have a direct positive effect on financial performance. These findings provide new evidence for improving financial performance in private hospitals in the KSA through the implementation of internal control and financial accountability measures. Further research could examine additional factors that may impact financial performance in the healthcare sector.</div

Discriminant validity using Fornell and Larcker’s approach (n = 78).

Discriminant validity using Fornell and Larcker’s approach (n = 78).</p

Descriptive statistics of the partial least-squares-structural equation model (n = 78).

Descriptive statistics of the partial least-squares-structural equation model (n = 78).</p

Indicator reliability, construct reliability, and convergent validity (n = 78).

Indicator reliability, construct reliability, and convergent validity (n = 78).</p

Structural model testing for financial accountability (FA) as a mediator between internal control and financial performance (FP).

CA, control activities; IC, information communication; ME, monitoring and evaluation; RA, risk assessment.</p

Relationships between internal controls, financial accountability, and financial performance.

Relationships between internal controls, financial accountability, and financial performance.</p

Socioeconomic and demographic characteristics.

Socioeconomic and demographic characteristics.</p

Discriminant validity assessment using the Heterotrait-Monotrait approach (n = 78).

Discriminant validity assessment using the Heterotrait-Monotrait approach (n = 78).</p

Structural model used to test the direct influence of internal control components on financial performance (FP).

CA, control activities; IC, information communication; ME, monitoring and evaluation; RA, risk assessment.</p

Multicollinearity evaluation among the internal control components (n = 78).

Multicollinearity evaluation among the internal control components (n = 78).</p