There have been calls for cost-effective public services and the integration of management control and risk management systems. Municipalities currently need to consider aging populations and diminishing financial resources. But municipal services may also include other risks, such as reputational and political risks, along with changes in legislation as well as unexpected changes in operating circumstances. Risks and how they are managed affect both the costs and the effectiveness of municipal services. However, cost-effectiveness and risks are not clear-cut concepts, especially in the public health services. Therefore, in order to better understand risks in public sector management control, these concepts need to be analysed together. In our qualitative case research setting, we analyse public health care management and risks. Combining our findings from the field with existing theories we present Control Cube (Kontrollikuutio) as a new construct that combines cost-effectiveness and risk management within the health service provision context. In more detail, we analyse cost-effectiveness, risk dimensions (financial, operative and legitimative risks), and prioritization in public health care services.