Accountability and Responsibility in Health Care

What is it about accountability that makes it so difficult to capture in words? There is a great deal of variety in how leading dictionaries and health care analysts use the term “accountability.” Semantic variety can lead to miscommunication and confusion, but perhaps it implies that words cannot always capture essence.
This introductory essay begins with a review of the various meanings of accountability and then specifies how we will use the term. We then explore the significance, limits, and implications of accountability in health systems, discussing, seriatim: the shift from responsibility to accountability in health systems, the nature and problems of performance management, the role of sanctions, and truncated vs. full accountability. There follows a section on accountability as a not strictly technical mechanism, and a brief conclusion suggests that the approach taken in trying to achieve accountability must be …