How Environmental Cost Accounting Can Transform Hospital Medical Waste Policies

Rigel Nurul Fathah; Teti Anggita Safitri

doi:10.14414/tiar.v16i1.5597

Vol. 16 No. 1 (2026), Articles

Vol. 16 No. 1 (2026)

How Environmental Cost Accounting Can Transform Hospital Medical Waste Policies

Articles

DOI: 10.14414/tiar.v16i1.5597

Published 2026-04-28

Rigel Nurul Fathah⁺⁻
Teti Anggita Safitri ⁺⁻

Rigel Nurul Fathah

Universitas Aisyiyah Yogyakarta

https://orcid.org/0000-0002-9243-0846

Teti Anggita Safitri

Universitas Aisyiyah Yogyakarta

https://orcid.org/0000-0003-0366-9466

PDF

Keywords

Environmental management disclosure
medical waste
Hospital accounting
Environmental cost
Corporate Social Responsibility (CSR)

How to Cite

Fathah, Rigel Nurul, and Teti Anggita Safitri. “How Environmental Cost Accounting Can Transform Hospital Medical Waste Policies”. The Indonesian Accounting Review, vol. 16, no. 1, Apr. 2026, pp. 15-30, https://doi.org/10.14414/tiar.v16i1.5597.

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Abstract

This study examines the implementation of environmental cost management in hospital waste management using the Environmental Management Accounting (EMA) framework. In Indonesia, hospitals increasingly implement environmental management practices, yet the integration of environmental costs into formal accounting systems remains limited. This research aims to analyze how environmental costs related to medical waste management are identified, measured, and recorded in hospital accounting practices. The study adopts a qualitative single case study approach conducted at PKU Muhammadiyah Nanggulan Hospital. Data were collected through semi-structured interviews, document analysis, observations, and financial records from 2023 to 2024 and analyzed using thematic analysis. The findings indicate that the hospital has implemented several environmental management practices, including medical waste segregation, wastewater treatment through IPAL facilities, and cooperation with certified third-party waste management companies. However, environmental costs are still recorded as general operational expenses under the IPAL account, without a clear classification in line with EMA principles. Integrating EMA into hospital accounting systems could improve transparency into environmental costs, strengthen environmental accountability, and support corporate social responsibility in sustainable healthcare management.

References

Adisty, L., Espa, V., & Damayanti, F. (2024). Analysis Implementation of Green Accounting in Medical Waste Management at RSUD dr. Agoesdjam Ketapang. Jurnal Pendidikan Akuntansi Dan Keuangan, 12(July), 179–188.

Aftab, J., Wei, F., Abid, N., Kiran, A., & Aftab, F. (2025). From CSR to environmental gains: examining the roles of AI change readiness, green entrepreneurial orientation, intellectual capital and value co-creation. Journal of Intellectual Capital, (March), 1–36. https://doi.org/10.1108/JIC-07-2025-0310

Ahdiat, A. (2024). Millions of Tons of Unmanaged Waste in Indonesia. In Kementrian Lingkungan Hidup dan Kehutanan (Number 6, pp. 2022–2023). https://databoks.katadata.co.id/en/environment/statistics/669784b69baf4/millions-of-tons-of-unmanaged-waste-in-indonesia

Akif Destek, M., Hossain, M. R., & Khan, Z. (2024). Premature deindustrialization and environmental degradation. Gondwana Research, 127, 199–210. https://doi.org/10.1016/j.gr.2023.06.006

Asiri, N., Khan, T., & Kend, M. (2020). Environmental management accounting in the Middle East and North Africa region: Significance of resource slack and coercive isomorphism. Journal of Cleaner Production, 267. https://doi.org/10.1016/j.jclepro.2020.121870

There are 41 references. More references >>

Adisty, L., Espa, V., & Damayanti, F. (2024). Analysis Implementation of Green Accounting in Medical Waste Management at RSUD dr. Agoesdjam Ketapang. Jurnal Pendidikan Akuntansi Dan Keuangan, 12(July), 179–188.

Aftab, J., Wei, F., Abid, N., Kiran, A., & Aftab, F. (2025). From CSR to environmental gains: examining the roles of AI change readiness, green entrepreneurial orientation, intellectual capital and value co-creation. Journal of Intellectual Capital, (March), 1–36. https://doi.org/10.1108/JIC-07-2025-0310

Ahdiat, A. (2024). Millions of Tons of Unmanaged Waste in Indonesia. In Kementrian Lingkungan Hidup dan Kehutanan (Number 6, pp. 2022–2023). https://databoks.katadata.co.id/en/environment/statistics/669784b69baf4/millions-of-tons-of-unmanaged-waste-in-indonesia

Akif Destek, M., Hossain, M. R., & Khan, Z. (2024). Premature deindustrialization and environmental degradation. Gondwana Research, 127, 199–210. https://doi.org/10.1016/j.gr.2023.06.006

Asiri, N., Khan, T., & Kend, M. (2020). Environmental management accounting in the Middle East and North Africa region: Significance of resource slack and coercive isomorphism. Journal of Cleaner Production, 267. https://doi.org/10.1016/j.jclepro.2020.121870

Budianto, A. A., Herawati, N., & Seputro, H. Y. (2025). Exploring Environmental Costs in Environmental Pollution Prevention Efforts: A Case Study of the Shalempang Batik MSME. Jati: Jurnal Akuntansi Terapan Indonesia, 08(02), 192–207. https://doi.org/10.18196/jati.v8i2.27995

Burritt, R. L., & Schaltegger, S. (2010). Sustainability accounting and reporting: Fad or trend? Accounting, Auditing & Accountability Journal, 23(7), 829–846. https://doi.org/10.1108/09513571011080144

Cartier, Y. (2013). Cartier Safe Management of Waste. World Health Organization.

Christ, K. L., & Burritt, R. L. (2013). Environmental management accounting: The significance of contingent variables for adoption. Journal of Cleaner Production, 41, 163–173. https://doi.org/10.1016/j.jclepro.2012.10.007

DiMaggio and Powell. (1983). The Iron Cage Revisited : Institutional Isomorphism and Collective Rationality in Organizational Fields. American Sociological Review, 48(2), 147–160.

Freeman, R. E., Harrison, J. S., Wicks, A. C., Parmar, B. L., & de Colle, S. (2010). Stakeholder Theory: The State of the Art. Cambridge University Press. https://doi.org/DOI: 10.1017/CBO9780511815768

Golob, U., Podnar, K., Elving, W. J., Ellerup Nielsen, A., Thomsen, C., & Schultz, F. (2013). CSR communication: Quo vadis? Corporate Communications: An International Journal, 18(2), 176–192. https://doi.org/10.1108/13563281311319472

Gunarathne, N., & Lee, K. H. (2021). Corporate cleaner production strategy development and environmental management accounting: A contingency theory perspective. Journal of Cleaner Production, 308(May). https://doi.org/10.1016/j.jclepro.2021.127402

Hanif, S., Ahmed, A., & Younas, N. (2023). Examining the impact of Environmental Management Accounting practices and green transformational leadership on corporate environmental performance; the mediating role of green process innovation. Journal of Cleaner Production, 414(May). https://doi.org/10.1016/j.jclepro.2023.137584

Huynh, Q. L., & Nguyen, V. K. (2024). The Role of Environmental Management Accounting in Sustainability. Sustainability (Switzerland), 16(17), 1–21. https://doi.org/10.3390/su16177440

Jasch, C. (2006). Environmental management accounting (EMA) as the next step in the evolution of management accounting. Journal of Cleaner Production, 14(14), 1190–1193. https://doi.org/10.1016/j.jclepro.2005.08.006

Kaposi, A., Nagy, A., Gomori, G., & Kocsis, D. (2024). Analysis of healthcare waste and factors affecting the amount of hazardous healthcare waste in a university hospital. Journal of Material Cycles and Waste Management, 26(2), 1169–1180. https://doi.org/10.1007/s10163-024-01890-1

Larrinaga, C., & Bebbington, J. (2021). The pre-history of sustainability reporting: a constructivist reading. Accounting, Auditing and Accountability Journal, 34(9), 131–150. https://doi.org/10.1108/AAAJ-03-2017-2872

Liu, X., Liu, S., Wang, J., & Chen, H. (2024). Does internal control affect corporate environmental responsibility? Evidence from China. International Journal of Emerging Markets, 20(9), 3760–3781. https://doi.org/10.1108/IJOEM-06-2023-0955

Meyer, J. W., & Rowan, B. (1977). Institutionalized Organizations : Formal Structure as Myth and Ceremony. American Journal of Sociology, 83(2), 340–363. https://www.jstor.org/stable/2778293

Mukwarami, S., Nkwaira, C., & van der Poll, H. M. (2023). Environmental Management Accounting Implementation Challenges and Supply Chain Management in Emerging Economies’ Manufacturing Sector. Sustainability (Switzerland) , 15(2). https://doi.org/10.3390/su15021061

Nematollahi, H., Tuysserkani, M., & Nematollahi, A. (2025). Medical waste management in the modern healthcare era: A comprehensive review of technologies, environmental impact, and sustainable practices. Results in Engineering, 28(August). https://doi.org/10.1016/j.rineng.2025.107210

Ningly, E., & Rahmadani, S. (2025). Enhancing Corporate Environmental Performance Through Green Process Innovation: A Sustainable Business Approach.pdf. Jurnal Akuntansi UNTAR, 29(2), 377–399.

Olukanni, D. O., Lazarus, J. D., & Fagbenle, E. (2022). Healthcare Waste Management Practices in Nigeria: A Review. Health Care Waste Management and COVID 19 Pandemic: Policy, Implementation Status and Vaccine Management, 197–218. https://doi.org/10.1007/978-981-16-9336-6_9

Purwanti, A., Dewantara, B., Nurcahaya, C., Gunadarma, U., & Sriwijaya, P. N. (2025). The integration of environmental costs into financial reporting: a green accounting perspective penerapan biaya lingkungan dalam laporan keuangan: perspektif akuntansi hijau. Journal of Economic, Business and Accounting, 8(5), 582–587.

Putri, S. Y., Widajantie, T. D., & Wilasittha, A. A. (2024). A Comparative Analysis Before and After PAndemic on Environmental Accounting Public Hospital. International Journal of Financial, Accounting , and Management (IJFAM), 6(1), 1–17.

Qian, W., Burritt, R., & Monroe, G. (2011). Environmental management accounting in local government: A case of waste management. Accounting, Auditing and Accountability Journal, 24(1), 93–128. https://doi.org/10.1108/09513571111098072

Rahmawati, T., & Hamzah, A. (2025). Green Accounting Enhances Sustainability Report Integrity : Does Governance Support Voluntary Disclosure Perspectives_. Jurnal Akuntansi UNTAR, 29(3), 448–468.

Rohim, A. S. M., & Hardiningsih, P. (2022). Green Accounting Rumah Sakit Umum Daerah R.A. Kartini Jepara. AKSES, 17(1), 45–53.

Saghita, Purna, a E. (2017). Pengelolaan Limbah Padat Medis Di Rumah Sakit. Iptekin, 3(1), 89–94.

Saizarbitoria, I. H., Boiral, O., Allur, E., & Garcia, M. (2020). Communicating Environmental Management Certification : Signaling without signals? Business Strategy and the Environment, 29(2), 422–431.

Saribu, A. D., Muda, I., Bukit, R. B., & Nasution, A. A. (2024). The Role of Environmental Management Accounting (EMA) in Hospital Performance Moderating the Effect of Green Innovation. Journal of Hunan University Natural Sciences, 51(6). https://doi.org/10.55463/issn.1674-2974.51.6.28

Sary, I. G., Utami, H., & Andayani, E. S. (2022). Analysis of Environmental Management Accounting Implementation in RSUD Dr. Saiful Anwar Malang. International Journal of Accounting Finance in Asia Pasific, 5(2), 27–39. https://doi.org/10.32535/ijafap.v5i2.1591

Sharma, C., Gupta, S., Kumar, V., & Kumar, V. (2025). Hospital-associated effluents: the masked environmental threat that needs urgent attention and action. Discover Applied Sciences, 7(1). https://doi.org/10.1007/s42452-024-06456-2

Singh, N., Ogunseitan, O. A., & Tang, Y. (2022). Medical waste: Current challenges and future opportunities for sustainable management. Critical Reviews in Environmental Science and Technology, 52(11), 2000–2022. https://doi.org/10.1080/10643389.2021.1885325

Sumiari, K. N., Pramitari, I. G. A. A., Wirayana, I. M. A., Parnata, I. K., & Setyastrini, N. L. P. (2025). Green Accounting in Healthcare: Strategic Framework for Sustainable Hospital Management. Jurnal Ilmiah Akuntansi Kesatuan, 13(5), 1421–1434. https://doi.org/10.37641/jiakes.v13i5.3729

Sutrisna, S., & Anna, S. (2019). Penerapan Akuntansi Lingkungan Terhadap Pengelolaan Limbah Bahan Berbahaya Beracun (B3) pada RSUP DR. Wahyudin Sudirohusono Makasar. Jurnal Riset Terapan Akuntansi, 3, 89–105.

Verlicchi, P., Al Aukidy, M., Galletti, A., Petrovic, M., & Barceló, D. (2012). Hospital effluent: Investigation of the concentrations and distribution of pharmaceuticals and environmental risk assessment. Science of the Total Environment, 430, 109–118. https://doi.org/10.1016/j.scitotenv.2012.04.055

Wang, T., Ismail, K., & Abas Azmi, K. S. (2022). The Rise of MCS and EMA in the Sustainable Field: A Systematic Literature Analysis. Sustainability (Switzerland), 14(24). https://doi.org/10.3390/su142416532

Yudha, M., Idris, A., Mansur, F., & Hernando, R. (2025). Pertumbuhan Profitabilitas. Jurnal Akuntansi Dan Keuangan Universitas Jambi, 10(01), 102–114. https://doi.org/10.22437/jaku.v10i01.45654

Zahrani, O. P., Yusrianti, H., & Kartasari, S. F. (2026). Systematic Literature Review (SLR): The Influence of Intellectual Capital On Financial Performance in Developed and Developing Countries. Al Kharaj : Journal of Islamic Economics and Business, 8(1), 453–463.

How Environmental Cost Accounting Can Transform Hospital Medical Waste Policies

Keywords

How to Cite

Download Citation

Abstract

References