One of the most striking features of recent public sector reform in Europe is privatization. This development raises questions of accountability: By whom and for what are managers of private for-profit organizations delivering public goods held accountable? Analyzing accountability mechanisms through the lens of an institutional organizational approach and on the empirical basis of hospital privatization in Germany, the article contributes to the empirical and theoretical understanding of public accountability of private actors. The analysis suggests that accountability is not declining but rather multiplying. The shifts in the locus and content of accountability cause organizational stress for private hospitals.