Table 1 Audit question formulation...

Table 1

Audit question formulation process

Theory of change component	International criteria	Audit question examples (from actual reports)	Focus
Objectives	Relevance	Social Benefits: Were they planned based on identified needs?	Systemic
		Renal Care: Were resources planned according to identified needs?
		Hospital Services: Are pricing objectives coherent with the Health Plan?
Objectives and resources	Coherence	Social Benefits: Are they coherent among themselves and with complementary social and sectoral policies?	Systemic
		Renal Care: Is territorial planning coherent and does it address coordination gaps between care levels?
		Hospital Services: Do services and programmes align with strategic health plan axes?
Resources	Economy	Social Benefits: Are resources and amounts sufficient to cover needs?	Systemic
		Renal Care: Was service cost determined using economy criteria?
		Hospital Services: Does contracting adhere to uniform, objective criteria respecting economy principles?
Resources and activities	Efficiency	Social Benefits: Do procedures comply with timelines? What controls have been implemented?	Process
		Renal Care: Are resources sufficient and is their relationship with services efficient?
		Hospital Services: Does compensation appropriately reflect structural differences and case complexity among providers?
Outcomes and impacts	Effectiveness	Social Benefits: Has access been guaranteed? What outcomes have been achieved?	Results
		Renal Care: What mechanisms monitor user satisfaction and clinical outcomes? Are they systematically applied?
		Hospital Services: Have economic incentives achieved their intended effects?
Outcomes	Equity	Social Benefits: Does the eligible population correspond to identified social needs, particularly among vulnerable and territorial groups?	Results
Outcomes	Equity	Renal Care: Do policies address vulnerable groups’ needs?	Results
Governance (cross-cutting)	Transparency and accountability	Social Benefits: Are there transparency and oversight mechanisms for improper payments?	Systemic
		Renal Care: Is there monitoring to ensure contract compliance and quality?
		Hospital Services: Does contracting apply objective criteria and maintain documented economic justification for pricing?

Theory of change component	International criteria	Audit question examples (from actual reports)	Focus
Objectives	Relevance	Social Benefits: Were they planned based on identified needs?	Systemic
		Renal Care: Were resources planned according to identified needs?
		Hospital Services: Are pricing objectives coherent with the Health Plan?
Objectives and resources	Coherence	Social Benefits: Are they coherent among themselves and with complementary social and sectoral policies?	Systemic
		Renal Care: Is territorial planning coherent and does it address coordination gaps between care levels?
		Hospital Services: Do services and programmes align with strategic health plan axes?
Resources	Economy	Social Benefits: Are resources and amounts sufficient to cover needs?	Systemic
		Renal Care: Was service cost determined using economy criteria?
		Hospital Services: Does contracting adhere to uniform, objective criteria respecting economy principles?
Resources and activities	Efficiency	Social Benefits: Do procedures comply with timelines? What controls have been implemented?	Process
		Renal Care: Are resources sufficient and is their relationship with services efficient?
		Hospital Services: Does compensation appropriately reflect structural differences and case complexity among providers?
Outcomes and impacts	Effectiveness	Social Benefits: Has access been guaranteed? What outcomes have been achieved?	Results
		Renal Care: What mechanisms monitor user satisfaction and clinical outcomes? Are they systematically applied?
		Hospital Services: Have economic incentives achieved their intended effects?
Outcomes	Equity	Social Benefits: Does the eligible population correspond to identified social needs, particularly among vulnerable and territorial groups?	Results
Outcomes	Equity	Renal Care: Do policies address vulnerable groups’ needs?	Results
Governance (cross-cutting)	Transparency and accountability	Social Benefits: Are there transparency and oversight mechanisms for improper payments?	Systemic
		Renal Care: Is there monitoring to ensure contract compliance and quality?
		Hospital Services: Does contracting apply objective criteria and maintain documented economic justification for pricing?

Source(s): Authors’ elaboration based on operational audit reports from the Sindicatura de Comptes de Catalunya

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