Performance management (PM) has been developed to a central part of health care reforms. However, ideas of performance are traditionally contested in the health care sector and split up between a professional and a bureaucratic understanding of effective service delivery. With the rise of New Public Management, an additional layer of PM instruments has been put on the already existing structures. As a result, different PM regimes can be distinguished, which vary in the way they define performance, blame underperformance and design accountability instruments to ensure appropriate behaviour. The paper investigates the institutional design of PM schemes of three different cases – Denmark, Germany and England – which are representative for different PM regimes.