<![CDATA[This study examines the effects of human resource competence, regulatory compliance, and internal control on financial reporting quality and investigates the subsequent effect of financial reporting quality on managerial decision-making in vertical hospitals under the Ministry of Health of the Republic of Indonesia. A quantitative approach with a causal research design was employed. Primary data were collected through structured questionnaires distributed to 37 financial reporting staff selected using a saturated sampling technique. The data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) with SmartPLS 4. The results indicate that regulatory compliance has a positive and significant effect on financial reporting quality, whereas human resource competence and internal control do not have significant effects. Furthermore, financial reporting quality has a positive and significant effect on managerial decision-making, indicating that reliable, relevant, and accurate financial information supports more effective managerial decisions. These findings suggest that compliance with accounting standards and applicable regulatory requirements plays a more prominent role in enhancing financial reporting quality than individual competence and internal control mechanisms within the observed institutional context. The study contributes to the public sector accounting literature by providing empirical evidence on the determinants of financial reporting quality in government-affiliated hospitals and its implications for managerial decision-making. Practically, the findings highlight the importance of strengthening regulatory compliance and improving financial reporting processes. The study is limited by its small sample and sector-specific setting; future research should employ larger samples and broader institutional contexts.]]>
