This essay focuses on the balance between governmental control and enterprise autonomy by examining the Norwegian hospital reform. We describe the enterprise model and give a description of the policy instruments that the government, as owner, has for exercising power and control vis-à-vis the health enterprises. How the trade-off between autonomy and control is experienced and practiced is analyzed from an instrumental, an institutional, and an environmental perspective. The database comprises a survey collected from health enterprise executives and illustrative cases. The trade-off can be characterized as ambiguous and unstable and we ask whether it is possible to achieve a strategy to more appropriately balance the goals of control and autonomy.