Reshaping public accountability: Hospital reforms in Germany, Norway and Denmark

Abstract

The paper contributes to the literature of multi-level welfare governance and public accountability in the context of recent European hospital reforms. Focusing on the changing dynamics between regional and central governance of hospitals in Germany, Norway and Denmark, we raise concerns about the reshaping of traditional public accountability mechanisms. We argue that, triggered by growing financial pressures, corporatization and professionalization processes have increasingly removed decisionmaking power from regional political bodies in hospital funding and planning. National governments have tightened their control over the overall trajectory of their hospital systems, but they have also shifted significant responsibility downwards to the hospitallevel. This has reshaped public accountability relationships towards more managerial or professional types of accountability embedded within multi-level forms of governance.