Drivers of Sustainability Disclosure in the Healthcare Sector: Empirical Evidence From Portugal

Vollständiger Abstract

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ABSTRACT This study examines the determinants of online sustainability disclosure in the Portuguese public hospital sector, contributing to the growing literature on sustainability disclosure in healthcare organizations from a context that remains largely underexplored. Drawing on a multi‐theoretical framework that integrates Legitimacy Theory, Signaling Theory, Stakeholder Theory, Institutional Theory, and Upper Echelons Theory, the study employs manual content analysis of the official websites of Portuguese hospitals to construct a Sustainability Disclosure Index encompassing environmental, social, and strategy and governance dimensions. The results confirm that Portuguese hospitals are at an incipient stage of sustainability disclosure maturity, with an average disclosure rate of 32.9% and a marked prioritization of social over environmental information, a pattern interpreted as consistent with a predominantly symbolic strategy of legitimation directed at primary civic stakeholders. Regression analysis identifies hospital size, coastal geographic location, and board gender diversity as the primary positive drivers of sustainability disclosure, while financial variables, profitability and indebtedness, and political ideology do not reach statistical significance. These findings suggest that sustainability disclosure in Portuguese hospitals responds more to institutional visibility pressures and governance modernization than to financial incentives or political orientation, reflecting the logic of a centralized public health system in the absence of a mandatory reporting framework. This study makes two distinct contributions: it provides the first systematic empirical evidence on the determinants of sustainability disclosure in the Portuguese hospital sector, extending the geographic scope of a literature so far dominated by Spanish and Italian evidence; and it offers a theoretical contribution that uses Portugal's shared Southern European administrative heritage with Spain and Italy to interpret symbolic legitimation as a structural feature of public healthcare systems under scrutiny but without clear normative guidance, while identifying the degree of health‐system centralization as a boundary condition for the political ideology hypothesis. The study also offers practical recommendations for hospital managers and policymakers seeking to strengthen accountability and embed sustainability into the governance of the National Health Service.