Toward Disorganized Governance in Public Service Provision? The Case of German Sickness Funds

Abstract

Over many years now, the concept of “network” or “new governance” pervades the literature on public administration. It suggests a growing role for network-based governance downgrading both command-and-control bureaucracy and, if more implicitly, New Public Management (NPM). Challenging this reading, the article explores the relationship between network-based and (quasi-)market governance by investigating the policies of German health care insurance organizations, the so-called sickness funds, epitomizing the international movement towards focal agencies run at arm's length of Government. These policies reflect new forms of hybrid coordination in public service provision, leading into what can be coined disorganized governance and be characterized as a regime of hybrid coordination shaped by a nervous interplay of partnership-building and disruptive segregation, with important repercussions on the overall outcomes in the provision of health care.