Changing accountability regimes in hospital governance

Denmark and Norway compared

Abstract

As modern welfare states are reforming, relationships and processes of accountability in public sector systems are transforming. This transformation has consequences for the relationship between the public, political and administrative institutions as well as service production, and ultimately concerns democratic legitimacy. In this article we focus on the hospital systems in Norway and Denmark, and explore the changes in accountability relationships that have come about in conjunction with reforms over the last 10-15 years. Departing from the theoretical idea that accountability serves several different functions and the empirical observation that recent reforms in the two systems are diverging as much as converging, we find that health care reforms provide fruitful cases for studying changing accountability relationships. We argue that the Norwegian and Danish hospital sectors, in spite of reform variation, are both moving from a situation characterized by democratic-administrative accountability mechanisms towards an increased focus on performance-oriented accountability mechanisms that combine and intersect with more traditional notions of democratic and administrative accountability. Finally, and based on this finding, we explore the implications for further research on accountability changes and reform.