Toward a Framework for Comparing Accountability Regimes in Healthcare

Abstract The debate on accountability within the public sector has been especially lively over the past decade. Significant progress has been made in developing conceptual frameworks and typologies for characterizing different features and functions of accountability. At the same time, however, there has been a lack of sector-specific adjustment of such frameworks. In this chapter we present a framework for analyzing accountability within healthcare. The chapter makes use of the concept of “accountability regime” to signify the combination of different accountability forms, directions, and functions in operation at any given point in time. We show that reforms can introduce new forms of accountability, change existing accountability relations, or change the relative importance of different accountability forms. They may also change the dominant direction and shift the balance between different functions of accountability. We further suggest that developments in accountability regimes are best analyzed with a combination of top-down and bottom-up perspectives and that there is a need to develop research strategies to support this aim.