Dimensions of Accountability in Healthcare

Authored by: Karsten Vrangbæk , Haldor Byrkjeflot

The Routledge Handbook to Accountability and Welfare State Reforms in Europe

Print publication date:  November  2016
Online publication date:  November  2016

Print ISBN: 9781472470591
eBook ISBN: 9781315612713
Adobe ISBN: 9781317044208


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Several researchers have pointed out that the accountability discourse has expanded and that accountability has become a ‘magic word’ (Pollitt and Hupe 2011) associated with a multitude of reforms and organizational changes in the public as well as private sector. This has spurred a massive increase in the use of the term, but also a clustering on analyses centered on ‘a minimal conceptual consensus’, which we will also take as our point of departure (Bovens et al. 2014). A central part of the concept of accountability is the specification of relationships between actors and levels within systems, where actors have obligations to account for their decisions and behavior. Actors in these systems must explain and justify their behavior in forums of different kinds, and their account-giving may actually have consequences (Bovens 2007). Such general accountability frameworks are useful for overall analysis of accountability. Yet, they may not be equally applicable to all sectors and task areas, due to institutional peculiarities and functional differences. The aim of this paper is to explore how this accountability framework can be adapted to a specific sector – healthcare – and explore the usefulness of including concepts of function and direction in order to grasp the complexity of accountability regimes. The guiding question is: How can existing, general accountability frameworks be adjusted to capture important dimensions within the healthcare sector?

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