This article analyses the relationship between different modes of accountability in New Zealand's publicly funded health sector since 2001. It adopts a ‘multiple modes of governance’ framework, drawing on the findings of an evaluation of health system restructuring conducted between 2001 and 2005. In broad terms, governance of the health system has moved from a combination of hierarchy and market to a mixture of hierarchy and collaboration. This article assesses the degrees to which hierarchical and collaborative accountability regimes have clashed with or complemented each other. We also identify areas in which none of these modes of accountability operate.