In this article, we discuss how regulation of governance in healthcare has been shaped over the past decade. We describe the presuppositions under this movement. Searching and balancing was needed to meet the complexity of care management. This has to do with the fact that the external pressure on the regulator after incidents is high. Due to this pressure, it is necessary to constantly ensure that management-oriented regulation does not narrow to the supervision on the actor with final responsibility. The regulation of good governance requires reflectivity of the inspectors and is aimed at stimulating recoupling between management and shop floors. This requires space for experimentation for both managers and inspectors. To provide this space, we do not only need a political and social debate about the quality of care and its management, but also attention and appreciation for the difficult considerations of organizing care.

In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in our knowledge by analyzing the results of a survey study among Dutch executives about mergers between healthcare organizations in the period from 2005 to 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increased competition, more pressure from purchasers (health insurers), growing financial risks, de-institutionalization of long-term care and decentralization of healthcare services to municipalities. Our study shows that Dutch healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Efficiency and financial reasons are also important drivers of merger activity in healthcare. Motives for mergers seem to be related to changes in health policy, in particular to the increasing pressure from competitors, insurers and municipalities.