Abstract The challenges of the post-golden age of the welfare state have led to reforms, which also concern the governance of welfare organizations. Linking public administration and social policy research, the article sheds light on the transformation of health insurance administration in the three corporatist welfare states Germany, France, and the Netherlands. The article concentrates on stakeholder participation via boards. The findings are assessed using an analytical framework based on the trichotomy exit, choice, and voice, which is a further development of the work of Albert O. Hirschman (1970). The article shows that the dimension of public involvement (‘collective voice’), although in urgent need of adaption, has been neglected in the process of reforms, especially in Germany and France.