Which conditions foster accountability for health policy implementation in Spain’s 17 regional governments? We analyze five conditions: private management of health services, political salience of health policies, governments’ left ideological position, strong presence of non-statewide parties, and minority governments. We use fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify how necessary and/or sufficient these conditions are (alone or in combination) to foster accountability. We find that there is no single recipe to ‘cook’ accountability. Three conditions appear to be ‘quasi-necessary’ but must be combined with others to foster accountability, thus defining three routes to accountability. The implications of the findings are discussed in light of current debates on the effects of decentralization, left-right ideologies, and privatization, on accountability for public policies.