Explaining Outcomes in Inter-Municipal Cooperation in Norwegian Out-Of-Hours Primary Health Care – The Role and Interplay of Network Structures and Processes

Inter-municipal cooperation (IMC) has gained widespread recognition as an effective and viable strategy for dealing with issues of scale and complexity in public service delivery, and it seems to be a prevailing consensus on... [ view full abstract ]

Inter-municipal cooperation (IMC) has gained widespread recognition as an effective and viable strategy for dealing with issues of scale and complexity in public service delivery, and it seems to be a prevailing consensus on the many benefits associated with this type of cooperation. Less attention, however, has been given to the additional costs, and how inter-organizational structures and processes may affect outcomes in a broader sense. Based on survey-data derived from local health managers in 266 Norwegian municipalities involved in IMC in Out-Of-Hours (OOH) services, this study aimed to investigate how variation in network structures and processes affects and play together in determining the perceived benefits and costs of being involved in IMC. The results suggest that the quality of network processes (trust and consensus) are likely to increase the perceived benefits and reduce the costs of IMC involvement, as well as well as playing a mediating role between network structure and perceived outcomes. The quality of network processes, on its part, seems to be fostered by network maturity, a decreasing number of participants, and more brokered and centralized forms of governance.