In hospital context, some studies found that a firm’s external environment influences the
cost-system functionality within the hospitals (Hill, 2000; Kettelhut, 1992; Pizzini, 2006). Hospitals that operate in markets with strong competition and/or significant penetration from manage-care organizations face greater external pressure to control costs and therefore require more extensive and detailed cost information (Hill, 2000; Kettelhut, 1992).