1. Introduction
Over the last decade, technological advances generated by the increasing use of technologies, such as artificial intelligence (AI), big data (BD), blockchain (BC), cloud computing (CC), and the Internet of Things (IoT), were the vectors of the technological revolution known as Industry 4.0. The emergent technologies significantly affect cost reduction, efficiency enhancement, and profit-boosting [
1]. Various industries and service activities [
2], including the healthcare industry [
3] and public administration [
4], implemented these emerging technologies in their early stages. Research and reports of professional bodies highlighted the significant changes already applied and those that will take place in the future in accounting management (AM) [
5,
6,
7,
8]. Digital transformation (DT) in AM began several decades ago with the implementation of IT solutions. Nevertheless, the entire process of AM is undergoing profound and paradigmatic transformation with the implementation of AI, BD, BC, CC, or IoT technologies.
New technologies make it possible to process and interpret large amounts of data in real time, strengthening transparency and generating increased confidence. Various researchers [
9,
10,
11,
12,
13,
14,
15,
16,
17,
18] show that IoT, BD, AI, and CC used in healthcare improved planning, decision-making, and treatment with a reduced time and cost. IoT ensures decision-making in time [
10,
11,
12,
13,
14,
18], based on the collection and processing of BD [
9,
15,
17], shared with CC technology [
10,
16]. AI solves routing, traffic engineering, resource allocation, and security [
10,
15]. Combined, new digital technologies could enhance effective healthcare delivery [
10,
15,
17]. New technologies are helpful throughout the AM process, from data collection to final decision-making. New technologies can facilitate and efficiently perform most operations within cost accounting tools (CAT), both traditional and innovative in the healthcare industry. (AI, BD, BC, CC, or IoT). IT solutions for costing, such as EasyKost, CostPerform, Boothroyd Dewhurst DFMA Software, Price Cost Analytics (PCA), or IT solutions for managing and planning enterprise resources, such as Oracle NetSuite, SAP ERP, Acumatica, and BizAutomation, are software that has dramatically transformed cost accounting. The next step, however, is the integration of technologies, such as AI, BD, BC, CC, or IoT within these IT solutions to make cost accounting more efficient. Some IT solutions, such as Oracle ERP Cloud and SAP S/4 HANA, already integrate AI, CC, or IoT technologies. However, user acceptance of digital technologies in already existing IT solutions is a gap that the paper identified in the digital accounting literature. The complexity of the activities, the multitude of cost elements, the specifics of the clients (patients who benefit from medical services), the characteristics regarding the privacy of the medical act and the transparency of expenses with medical services, and the difficulty of evaluating the activities of physicians and auxiliary staff represent specific features of accounting management in the healthcare industry.
Based on the gap found in the literature, this study aims to evaluate the effects of DT generated by implementing emerging technologies, such as AI, BD, BC, CC, or IoT, in the traditional and innovative CAT. The paper highlights the impact of the costing activity digitalization on improving costing processes and organizational performance in the healthcare industry. The empirical study implies a survey based on a questionnaire given to accountants with seniority in cost accounting in the Romanian healthcare industry. The paradigm-shifting in costing activity due to the DT was investigated by reviewing the literature. The study has an innovative character through the research topic addressed (DT of costing tools) and its practical utility for specialists in AM in the healthcare industry. Most costing operations can be translated into a controlled and accessible digital environment.
The structure of the paper has six sections: the introduction is followed by the literature review, methodology, and findings sections. Finally, the paper ends with discussions, conclusions, research, and future research directions.
4. Results
To investigate the influence of DT on traditional and innovative CAT and organizational performance proposed in the theoretical model, the paper use SmartPLS v3.0 (SmartPLS GmbH, Oststeinbek, Germany), which conducted SEM in a partial least square variant. The investigation uses a reflective model. PLS algorithm is used for validation, outer loadings, and outer weights, while a bootstrapping procedure supplies path coefficients in SmartPLS 3.0.
Figure 2 shows the theoretical model applied.
The reliability and validity are excellent (
Table 4). Also, the model records values below 0.08 (0.078) for SRMR (standardized root mean squared residual) and values over 0.9 (0.917) for NFI (normed fit index), proving a good fit for the model.
All validity and reliability measures presented in
Table 4 confirm good reliability and validity, according to [
80].
Confirmation of the validity of hypotheses H1 and H2 involved the analysis of outer loadings and outer weights to determine the most important antecedent of the latent variables. (
Table 5).
The analysis of the outer loadings and outer weights in
Table 4 confirms that hypothesis H1 is valid. The most useful traditional CAT in the users’ perception is AC, while the most useful innovative CAT in the users’ perception is TC. The results are similar to other research conducted among accountants in other countries [
9,
26,
71].
Among the antecedents of the DT influence, the most important are rapidity and security in the users’ perception, which confirms a partial validation of the H2 hypothesis. The real-time feature of CAT operations makes rapidity the antecedent with the highest outer loading and outer weights. Other research results confirm the importance of real-time accounting operations [
55,
59,
60]. Although data security is a crucial issue, especially in financial accounting and auditing, the users indicated information security as a critical feature of digital technologies, including cost accounting in the healthcare industry.
Following a bootstrapping procedure in SmartPLS 3.0 (with 500 subsamples and a significance level of 0.05), the path coefficients indicate significant positive direct influences among model variables (
Table 6). Values above 1.6 for T statistics and below 0.005 for
p values show an increased relevance of the path coefficients [
70].
Path coefficients in
Table 5 reveal a more substantial positive influence of digital technologies on the innovative CAT than in the case of the traditional CAT, which confirms the H3 hypothesis. Furthermore, the validity of the H4 hypothesis confirms the significant positive influence of the perceived innovative CAT improved through DT usefulness on organizational performance, compared to the perceived traditional CAT improved through DT usefulness, in line with the results of other research [
9,
10,
11,
12,
13,
14,
15,
16].
5. Discussion
The expansion of Industry 4.0 has led to the development of most cost accounting tools, both traditional and innovative CAT, including in the healthcare industry. The development of cost accounting and control practices in modern companies took place mainly between 1850 and 1925 [
28] when most traditional CAT emerged, with the rise of scientific management. The information provided by traditional CAT helped analyze operational efficiency in the decision-making process regarding pricing and the activities regarding control and motivation. The main disadvantage of the traditional CAT is a limited vision at the workplace level or the cost unit and an incomplete overview of the financial and general performance [
22]. The paper analyzed the perception of selected respondents (Romanian accountants in the healthcare industry) on traditional and innovative CAT. Similar to other research [
19,
26,
81], the paper found the prevalence of innovative CAT over traditional CAT, but traditional CAT are still intensely used in the healthcare industry due to lower costs, time consumption, and lack of skills. The investigation of the H1 hypothesis revealed that absorption costing is the most used tool in the healthcare industry among the traditional CAT. In contrast, among the innovative CAT, the most used tool in the healthcare industry is target costing, based on outer loading and outer weights of exogenous variables. The results were in line with the findings of other researchers [
28,
29,
30].
The digitization of cost accounting in the healthcare industry supposes the automation of the accounting processes to facilitate the accomplishment of routine tasks and access to information in real-time on costs [
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
82,
83]. In line with the findings of other authors [
81,
82,
83,
84], the paper on the H2 hypothesis revealed the characteristics of the digital technologies implemented in traditional and innovative CAT appreciated by the respondents. The rapidity of operations (in real-time) and information security are the essential features of digital technologies implemented in traditional and innovative CAT that influence their efficiency and effectiveness. Moreover, the other features selected from the literature on technology acceptance [
54,
55,
59,
60,
61,
62,
63,
70,
78], i.e., customization, trust, and accessibility, record high values of outer loadings and outer weights in the healthcare industry, proving their relevance for accountants.
Currently, the entire AM process undergoes a profound and paradigmatic DT through AI, BD, BC, CC, or IoT technologies [
6]. While CC makes it possible to store and use BD, BD and IoT can be combined with AI technology [
10,
56]. BD is a critical component of AI technology because AI is based on machine learning. Through CC, data on costs collected and IoT can be stored, and AI can effectively process and interpret these BD, helping substantiate cost decisions. Therefore, new digital technologies underlie the construction of more advanced costing IT solutions, providing high-quality information with substantial time and cost savings and contributing to accounting transparency and autonomy in the healthcare industry.
Regarding information transparency and reliability, BC technology can play a crucial role in contributing to information security activities. Manipulating cost records is extremely difficult because they are shared by all network participants using cryptography [
56]. The costing accounting process can be considerably developed by joining each item of innovative technologies, as found by other researchers who applied the TAM model in other fields [
72,
73,
74,
75,
76,
77,
78]. By validating the H3 hypothesis, the paper confirmed the significant positive influence of DT on CAT in the healthcare industry, with innovative CAT being much more useful in users’ perception after implementing digital technologies than traditional CAT.
Implementing information technologies in the costing activity brings several advantages [
84]. DT allows simple and repetitive tasks in a short time and without human effort, supported by CC technology that permits quick sharing of information. BC provides high information security and improves transparency. Activities that involve a large amount of information and are time-consuming, such as costing, can be improved by automating costing processes, leading to the improved overall performance of the organization [
54,
63]. In line with the findings of other researchers [
3,
69,
81], the investigation of the H4 hypothesis confirmed the influence, especially of perceived innovative CAT improved through DT usefulness on the healthcare organizations’ performance through better management of the organizational costs. The opportunities offered by digital technologies are substantial. Many processes within accounting and managerial information systems are made more efficient through innovation and digitization [
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
85,
86,
87], contributing to healthcare organizations’ high performance [
10,
38,
39,
40,
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55,
56,
57,
58,
59,
60,
61,
62,
63,
64,
65,
66,
67,
68,
69]. However, there are also several risks, obstacles, and challenges. The reluctance of cost accounting professionals to adopt digital technologies in their work and use them to make their work easier and achieve better results is a significant challenge that must be addressed [
88].
In addition to the advantages offered, there are several disadvantages of using these information technologies [
89]: the high skills level of human resources needed to use these technologies, the need to customize for each organization which requires time and effort, and the elimination of many jobs among accountants. However, the implementation of teleworking accelerated by the COVID-19 pandemic has determined a faster acceptance of digital technologies, including in the healthcare industry [
90].
Marr [
91] shows that it is not difficult to use information technologies in AM because AM is not mandatory. Therefore, cost calculation offers greater freedom for implementing technologies, such as AI, BD, BC, CC, or IoT, without ensuring compliance with specific rules or standards and accounting systems, as in the case of financial accounting or audit. However, despite all the advantages offered, activities that require social intelligence cannot be performed only by AI, particularly in the healthcare industry. For example, experts are still needed to use the information provided by these digital technologies to improve estimates and predictions by taking into account social and individual factors in the cost calculation process [
92]. In other words, at least at the current technological level, digital technologies can provide helpful information. However, the final decisions must belong to human beings, who can identify based on intuition and emotional intelligence factors that digital technologies ignore.
5.1. Theoretical Implications
CC is an essential tool that will lead to the DT of AM. CC, combined with BD and IoT, has brought various benefits to costing tools. In turn, BD is the vector underlying the use of AI technology in AM. BC can provide trust, reliability, transparency, and accessibility for costing tools that use digital technologies. DT is not just an acceptance of technologies and their formal use. The DT in cost accounting in the healthcare industry implies a paradigmatic, structural change that will lead to new costing tools in combination with new technologies. The new costing tools will derive from current IT solutions that integrate traditional or innovative tools, which will develop based on the growing capabilities offered by new technologies: AI, BD, BC, CC, or IoT.
Accountants are essential to building effective and valuable accounting and management information systems in the healthcare industry. Their collaboration with IT specialists in the design and maintenance of information systems, as creators and managers of information, can bring immense benefits to the field of accounting management [
93]. The role of efficient and valuable accounting and managerial information systems in information management is essential to ensure the information necessary for decision-making in the healthcare industry [
94]. New technologies transform cost accountants’ operational and tactical roles into strategic roles, accounting information systems being the basis of essential decision-making processes [
95].
5.2. Empirical Implications
This study aims to understand how new technologies can improve the application of traditional and innovative CAT and ultimately lead to increased organizational performance. The paper conducted theoretical and empirical research on academic literature based on a questionnaire applied to accountants with seniority in cost accounting in the Romanian healthcare industry, formulating four hypotheses. The validity investigation of the hypotheses led us to conclude that among the traditional CAT, the most used technique is absorption costing in the healthcare industry, while among the innovative CAT, the most used technique is target costing. The implementation of digital technologies in the healthcare industry can lead to the improvement of both traditional and innovative CAT. Among the characteristics of digital technologies implemented in traditional and innovative CAT in the healthcare industry, the rapidity of operations (in real-time) and information security influenced CAT efficiency and effectiveness. Empirical research has demonstrated that the prevalence of innovative CAT improved through DT over traditional CAT improved through DT due to the takeover of complex and time-consuming tasks by digital technologies. Moreover, the influence of CAT improved through DT on healthcare organizations’ performance is much more robust in the case of innovative CAT than in the case of traditional CAT.
5.3. Limitations and Further Research
The study’s main limitation comes from limited geographical representativeness, given that the subjects of the empirical study were only Romanian accountants with seniority in cost accounting in the healthcare industry. The study focuses on their perceptions of improving costing processes through DT and the impact of this improvement on healthcare organizational performance. Another limitation comes from the transversal approach, which provides a clearer picture of the situation and does not allow the analysis of the evolution over time of accountants’ perceptions. Future research directions arise from the limits of the paper and must take into account the geographical expansion of the researched population and a longitudinal approach that allows the analysis of trends in cost accounting. Extending the research area to other organizational processes, not only the costing activity, can be an essential and integrative direction of future research in the healthcare industry. Digital transformation affects all areas of the healthcare organization, and it is essential to evaluate the acceptance of users implementing new digital technologies.