Over the last decades an increasing number of mergers and acquisitions between Dutch healthcare organizations has taken place (up scaling). More recently there is a rise in the numbers of new small-scale healthcare organizations and small-scale care facilities (down scaling in the numbers). The wide variety of scales, each with its pros, cons and (historical) contexts, makes the existence of one optimal scale an illusion. Our research question is: when, and on the basis of which values, is scale of healthcare organizations legitimate? We answer this question by analyzing 650 newspaper articles from fourteen national newspapers. By using theory about legitimacy and values, we argue that five values underlie the public discussion on scale: governance, the human size, quality of care, market power and efficiency. We conclude that achieving legitimate scale involves dealing with those five values, which are not always commensurable and sometimes conflicting. With this article we contribute to the scientific debate about scale and values. We also give recommendations to policy makers and executives that can be used to improve the legitimacy of scale decisions.

In this contribution we introduce the principles of proper administration and the principles of good administration as public values and the definitions of these terms including the concept of good governance. Two main developments in relation to these principles are described here. The first line is from unwritten principles (developed by the judiciary) to written principles of proper administration by which there is in addition to the classical legal protection function, the instrumental function of these principles that has become more important. The second line is from the starting point of the principles of good administration - which can be found more in the legislation and the (policy)regulation but in a fragmentary way - to the application. This application is checked by the National Ombudsman, the Court of Audit and - more recent - also the European judiciary are working with these principles. For guaranteeing the public values there is - from the concept of good governance - now a need for integration of these principles of good administration in the Netherlands General Administrative Law Act and in the case law of the Netherlands judiciary.

Public Private Partnerships (PPP), especially those geared to exercise public legal powers (‘Authoritative PPP’), are suggestive of tensions between private party involvement and public legitimacy. Hence, public legitimacy is analyzed primarily on the basis of work done by David Beetham, and complemented with Public Law legitimacy considerations concerning the exercise of legal powers and law on public organizations. The findings project that there is room to convincingly frame legitimate PPP involving public authority, but that the scope is restricted both in terms of legal constraints and of political sensitivity.As a result of this, truly wicked policy projects, which in theory stand to gain most by PPP, in practice seem to be considered less suited for Authoritative PPP (and probably more for Network PPP).