PurposeThis study examines whether management accounting knowledge and limited managerial discretion encourage and/or hinder the use of management accounting.Design/methodology/approachBased on the data obtained from public hospitals in Japan, this study tests whether top managers with more management accounting knowledge use management accounting more. Additionally, the study verifies whether lower managerial discretion leads to the use of less management accounting and conducts hierarchical multiple regression analysis.FindingsThe results show that the higher management accounting knowledge is, the more likely management accounting is to be used. By contrast, the more limited management discretion is, the less likely management accounting is to be used.Originality/valueThe author's management accounting research based on the upper echelon theory has shown that characteristics such as the education and experience of top managers affect the use of management accounting systems. However, the impact of management accounting knowledge and managerial discretion, which is one of the important characteristics of top managers, on management accounting has rarely been studied.