PhD defence J.F.L. (Jolien) van de Sande

Below is a brief summary about the dissertation:

Since the 1980s, central governments across the globe have increasingly created semi-autonomous agencies operating at distance of their so-called ‘arm’s length’. These agencies are expected to realize enhanced public service delivery closer to citizens. Besides the pressure to realize these high expectations, they operate in-between the state, organized interests and individual citizens. Since agencies cannot be held accountable by individual citizens, they are expected to compensate through other public accountability practices. This expectation is particularly pressing when they make substantive decisions about salient issues in which conflicting public values are at stake. This book provides an in-depth qualitative analysis of the Dutch National Health Care Institute (Zorginstituut Nederland, ZiN) and thereby shows how public accountability can play a role in decision-making about conflicting public values by a semi-autonomous agency. The book shows that, in deciding on these values, the agency engages in three forms of public accountability. It shows that, although these multiple accountability forms and their strategic interaction have several advantages, they can also impede efficient decision-making in the public interest. The four conducted studies make clear that engaging in multiple accountability increases the complexity of the agency’s daily work. This complexity has resulted in uncertainty about the agency’s role in the Dutch healthcare system of regulated competition. The book further sheds light on the current endeavours of the agency and other institutional actors in Dutch health policy to work their way out of this complexity and reflects on the international trend of ‘agencification’.