Drivers and barriers of inter-municipal cooperation in health services – the Norwegian case

ABSTRACT

Inter-municipal cooperation in service delivery is widespread, as is the notion that this type of cooperation is primarily driven by economies of scale. However, the empirical results appear to be inconclusive, suggesting that additional explanatory factors are needed to explain why municipalities cooperate. This study aimed to identify the factors and conditions that influence the level of inter-municipal cooperation in health services by exploring a broad set of explanatory factors that go beyond simple economic concerns. In addition to confirming that a small population-size and fiscal stress constitute important drivers of inter-municipal cooperation, the results from this study also demonstrates the need to consider geographical location and heterogeneity relative to neighbouring municipalities as potential barriers to such cooperation.

KEYWORDS:

• Inter-municipal cooperation
• inter-local cooperation
• service delivery
• health care
• Norway
• institutional collective action

Acknowledgements

The authors would like to thank the University of Agder (grant number 98454) and Aust-Agder Development and Knowledge Fund (grant number 2013/3148-51) for funding this work. We also want to express our gratitude to the many managers of local healthcare services in Norway for taking the time to give us the necessary information.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. These values are reflected in the principle of generalist municipalities, which entails that all municipalities, regardless of size, are assigned the same set of statutory tasks, financing system, and legislation aimed at securing equal access to services for all inhabitants.

2. Given the principle of generalist municipalities which entails that all Norwegian municipalities are assigned the same set of statutory tasks and legislation, and our focus on the level of IMC more than what characterise of a single service, we expect the composition of affected jurisdictions to be of most relevance when studying IMC within the Norwegian context.

3. Statistics Norway is the central agency responsible for collecting, producing, and communicating statistics related to the economy, population and society at national, regional, and local levels in Norway.

4. The Norwegian Association of Local and Regional Authorities (Norwegian: KS) is a Norwegian employers’ and interest organization for municipalities, counties, and local public enterprises in Norway.

5. The respondents were explicitly asked only to provide information about IMC arrangements that are embodied in a written contract, agreement, or similar.

Additional information

Funding

This work was supported by the University of Agder [98454]; Aust-Agder Development and Knowledge Fund [2013/3148-51];

Notes on contributors

Bjørnulf Arntsen

Bjørnulf Arntsen is a PhD candidate at the Faculty of Health and Sport Science, University of Agder, Norway, where he is on leave from his position as a manager of the Centre for Caring Research, Southern Norway. Arntsen is a political scientist with research interests in the organisation of local health care and local government reform.

Dag Olaf Torjesen is an Associate professor in the Department of Political Science and Management, the University of Agder. He teaches public policy and governance and heads an executive master’s programme in health management. Torjesen is supervising the PhD project: ‘Local adaption to a national health care reform’. His main research interests are on reforms, management, organisation, and governance in health care.

Tor-Ivar Karlsen is an Associate professor at the Faculty of Health and Sports Science, University of Agder. He teaches public policy and healthcare planning and heads a master’s programme in public planning. His main research interests include public health, planning and quality of life research, mainly through surveys and statistical data analysis.