Abstract

BODE, Ingo. Paradoxical Accountability in Public Service Provision. The Case of Inpatient Care in Germany – and a Thought Experiment on Mexico. Gest. polít. pública [online]. 2017, vol.26, n.spe, pp.45-77. ISSN 1405-1079.

This article explores relations between public service-providing organizations and their wider environment, with an emphasis on the transformation of public accountability. The key assumption is that the latter becomes stronger and less immediate at the same time. This paradox will be elucidated by drawing on concepts such as institutional logics, market-oriented public governance, and hybrid accountability on the one hand, and by an empirical illustration from the German inpatient care sector which is complemented by a short foray into recent developments in the Mexican health care system, on the other. It is argued that, under the influence of recent reform movements, contemporary public service provision is fraught with the aforementioned paradox, regardless of (national) institutional legacies in public management. However, it seems that the paradox is more pronounced in mature welfare states, whereas in countries such as Mexico strong heterogeneity within the affected organizational fields may impede a fieldwide clash of institutional logics even as more basic functional problems remain crucial.

Keywords : governance; accountability; health care systems; institutional logics; Germany.

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