Service quality and the optimum number of members in intermunicipal cooperation: The case of emergency primary care services in Norway

Intermunicipal 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.