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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.

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.

AbstractGovernments engage in corporatization by creating corporate entities or reorganizing existing ones. These corporatization activities reflect an interplay between political agency and environmental pressures, including (changing) notions of state-market relations. This paper discusses two ideal-typed organizational models of corporatization: the state as a marketizer and the marketization of the state. Whereas the first emphasizes the role of political design and agency in corporatization, the second emphasizes the role of (actors in) the environment for corporatization. Both models are assessed across five corporatization episodes in Norway and Sweden, where we also demonstrate the interplay between political agency and environmental pressure.

Diagnosis Related Groups (DRGs) are used for financial and administrative purposes in hospital systems across the world, and are combined with a series of administrative tools to increase efficiency and effectiveness. Economic dysfunctions of such systems are widely reported, but the organizational basis of this managerial tool and the implications for hospital governance are less explored. This article shows, through eight case studies, how DRGs and waiting list management create opportunities for gaming in Norway and Germany. It argues that whereas these effects are relatively similar, the way they are handled by different accountability types varies considerably between Norway and Germany. Despite similarities in gaming and accountability challenges in the single cases studied, the Norwegian and German systems seem to cope with gaming in different manners, as could be expected: The institutional context creates premises for resolving such issues that vary more with the actual governance setting than with the nature of a given case. Both systems are marked by a certain ambiguity and complexity defined by reforms history, institutional dynamics, and administrative traditions: the German legal‐oriented, Bismarckian system is as ambiguous as the Norwegian consensus‐oriented Beveridge‐type system.

Central policymakers, governments, climate researchers, and research funders emphasize the necessity to develop, design, and implement climate change policies. This article investigates how this is dealt with in current social science research by analyzing relevant articles published in international academic journals. The search covers both interdisciplinary and more discipline-specific journals, focusing on publications within international relations, political science, public administration, and sociology. The results show that although climate change is a major contemporary research topic, there seems to be a lack of research focusing on existing government actions, multilevel governance, and implementation. The existing research is largely empirical and case-oriented. Cross-country comparisons are rare, and relatively few studies explicitly focus on theory development. A major proportion of the research is published in interdisciplinary journals, where vital insights from political science and public administration research might be lacking. This paper, through an analysis of extant research, will add to the body of literature on climate change policy from a public policy implementation perspective.

The article contributes to the literature on 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 have increasingly removed decision-making 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 have also shifted significant responsibility downwards to the hospital level. This has reshaped public accountability relationships towards more managerial or professional types embedded within multi-level forms of governance. Points for practitioners Our study may be taken to suggest that if reforms are responses to policy pressures, the accompanying changes in accountability relationships and arrangements in turn contribute to altering the pressures and constraints that form the context for administrative, managerial and professional work. As reforms in Norwegian, Danish and German healthcare contribute to corporatization, centralization and economization, there is reason to expect that what officials are held accountable for, and how, is also likely to change and to accentuate the span between policy aims and actual managerial and professional performance.

Notre article entend enrichir la littérature sur la gouvernance à niveaux multiples des services de santé et l'imputabilité publique dans le contexte des récentes réformes européennes des hôpitaux. C'est en nous intéressant à l'évolution de la dynamique entre la gouvernance régionale et la gouvernance centrale des hôpitaux en Allemagne, en Norvège et au Danemark que nous allons examiner les questions de réorganisation des mécanismes d'imputabilité publique traditionnels. Nous soutenons que sous l'effet du renforcement des pressions financières, la corporatisation et la professionnalisation ont eu pour effet de retirer progressivement leur pouvoir décisionnel aux organes politiques régionaux dans le domaine du financement et de la planification des hôpitaux. Les gouvernements nationaux ont renforcé leur influence sur la trajectoire globale de leurs systèmes hospitaliers, mais ils ont aussi transféré des responsabilités considérables vers l'échelon des hôpitaux. Ces évolutions sont à la base de nouvelles relations d'imputabilité publique, des relations davantage managériales ou professionnelles intégrées dans des formes de gouvernance à niveaux multiples. Remarques à l'intention des praticiens Notre étude laisse entendre que si les réformes sont des réponses aux pressions stratégiques, les changements qui les accompagnent dans les relations et les mécanismes d'imputabilité contribuent quant à eux à transformer les pressions et les contraintes qui forment le contexte de l'activité administrative, managériale et professionnelle. À mesure que les réformes mises en œuvre dans les soins de santé norvégiens, danois et allemands renforcent la corporatisation, la centralisation et l'économisation, on peut s'attendre à ce que les choses sur lesquelles les responsables doivent s'expliquer, et la façon de le faire, évoluent et creusent l'écart entre les objectifs stratégiques et la performance managériale et professionnelle réelle.