Abstract
AbstractIntermunicipal cooperation (IMC) is often used as a mean to reap scale benefits. Most studies on the effects of IMC focus on cost savings, while service quality is overlooked. In this study, the focus is set on input quality in a service characterized by high asset specificity and need for redundancy: emergency primary care. We analyze how mode of governance affect performance by (1) measuring whether IMC versus single‐municipal production affects input quality and (2) identifying optimum scale of operation; effect of the number of participants in the cooperation on input quality. The findings indicate that cooperation weakens the input quality of medical workforce, but that this negative effect is balanced out as the number of participants increases, indicating that cooperation needs to reach a certain size to achieve optimum scale of operation. Concerning equipment, both cooperation in general and an increasing number of participants decrease the input quality.
Highlights
Intermunicipal cooperation (IMC) has been proposed by scholars as an organizational solution in situations with small-scale production for over half a century (Ostrom et al, 1961) and is used on a large scale by municipalities worldwide
The general finding in this study is that cooperation—when production volume is held constant—has a negative effect of quality. This indicates that emergency primary care (EPC)—when input quality is a concern—is provided best by single municipalities
Like HolenRabbersvik (2019) that future research needs to address “how and when IMC is most beneficial” (p. vi). When it comes to generalizability, we argue that EPCs represents a type of service characterized by high asset specificity and a need for redundancy
Summary
Intermunicipal cooperation (IMC) has been proposed by scholars as an organizational solution in situations with small-scale production for over half a century (Ostrom et al, 1961) and is used on a large scale by municipalities worldwide. One important organizational element is clearly the number of owners (i.e., municipalities) participating in the cooperation as this may create problems with dispersed ownership and multiple principals (Aldag et al, 2020; Bel et al, 2014; Bel & Sebo}, 2021; Bel & Warner, 2015b; Blåka, 2017a, 2017b; Sørensen, 2007) It is a question of cooperating or not, and a question of optimal number of governing actors and potential challenges with multiple principals (Voorn et al, 2019)
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