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Antecedents and outcomes of inter-municipal cooperation in health services – A relational and contextual approach

Bjørnulf Arntsen of the Faculty of Health and Sport Sciences at the University of Agder has submitted his thesis entitled «Antecedents and outcomes of inter-municipal cooperation in health services – A relational and contextual approach» and will defend the thesis for the PhD-degree Friday 30 September 2022. (Photo: Private)

Taken together, the results from the three papers included in the thesis indicate that the traditional focus on internal characteristics of individual municipalities typically related to size and fiscal stress are not sufficient to understand variation in the participation and outcomes of IMC in health. Rather, our findings suggest a broader approach, an approach that also accounts for the relational and contextual aspects of IMC.

Bjørnulf Arntsen

PhD Candidate

You may follow the disputation online. Link for registration as an online spectator at the bottom of this page.

 

Bjørnulf Arntsen of the Faculty of Health and Sport Sciences at the University of Agder has submitted his thesis entitled «Antecedents and outcomes of inter-municipal cooperation in health services – A relational and contextual approach» and will defend the thesis for the PhD-degree Friday 30 September 2022. 

He has followed the PhD programme at the Faculty of Health and Sport Sciences.

Summary of the thesis by Bjørnulf Arntsen:

Antecedents and outcomes of inter-municipal cooperation in health services – A relational and contextual approach

The existing research literature on inter municipal cooperation (IMC) has mainly been limited to “hard” and technical services, primarily focusing on the potential to achieve cost savings through economies of scale.

Contextual and relational factors

Although important, however, this literature is not very helpful in providing a better understanding of the complexity and diversity of IMC established in “softer” health services.

Going beyond traditional economic explanations, the overall purpose of this thesis was to identify some of the contextual and relational factors that may help explain variation in the participation and outcomes of IMC in health services.

Three articles

The thesis includes three papers in which the following research questions were addressed:

  • Paper 1: Why do some municipalities participate in IMC more frequently than others when providing local health services?
  • Paper 2: How does the structure and quality of cooperative relationship interact to influence the perceived benefits and costs of being involved in IMC in out-of-hours health services?
  • Paper 3: How does size asymmetry between host municipalities and their partners affect the perceived service quality and autonomy costs of being involved in IMC?

Participation and outcomes

The three studies included in the thesis used a quantitative cross-sectional research design. Analyses were based on survey- and registry data obtained from a sample of Norwegian municipalities involved in IMC in health services.

In our study of the participation of IMC (paper 1), we found internal constraints resulting from small size and fiscal stress acting as important drivers of IMC while geographical distances and heterogeneity relative to neighboring municipalities seemed to act as contextual barriers.

In our two studies of the outcomes of IMC we found the perceived benefits and costs of IMC to be closely associated with the interplay between the structure and quality of the cooperative relationship (paper 2) and the degree of size asymmetry inherent in IMC organized according to a host municipality model (paper 3).

Findings

Taken together, the results from the three papers included in the thesis indicate that the traditional focus on internal characteristics of individual municipalities typically related to size and fiscal stress are not sufficient to understand variation in the participation and outcomes of IMC in health.

Rather, our findings suggest a broader approach, an approach that also accounts for the relational and contextual aspects of IMC.

Disputation facts:

The trial lecture and the public defence will take place online via the Zoom conferencing app - registration link below.

Head of the Department of Health and Nursing Sciences, Professor Mariann Fossum, Faculty of Health and Sport Sciences, University of Agder, will chair the disputation.

The trial lecture Friday 30 September at 09:15 hours

Public defence Friday 30 September at 11:30 hours

 

Given topic for trial lecture: «Aktuelle teorier og perspektiver i forståelse av fler-kommunalt samarbeid» ("Current  theories and perspectives in the understanding of inter-municipal cooperation")

Thesis Title: «Antecedents and outcomes of inter-municipal cooperation in health services – A relational and contextual approach»

Search for the thesis in AURA - Agder University Research Archive, a digital archive of scientific papers, theses and dissertations from the academic staff and students at the University of Agder.

The thesis is available here:

 

The Candidate: Bjørnulf Arntsen (1971, Risør) Major subject in Political Science (Cand.polit), UiO (2004). Major subject thesis title: «Konflikt og konsensus – en studie av mål, virkemidler og organisering innenfor Natur og Ungdom og Bellona». Employee (2000 – 2009) as Department manager at SERAF – Norwegian Centre for Addiction Research (UiO) and as a research assistant at ARENA Centre for European Studies (UiO). Present position - from 2009 - CEO at Centre for Care Research South (UiA).

Opponents:

First opponent: Professor Lars Erik Kjekshus, Department of Sociology and Human Geography, University of Oslo

Second opponent: Associate Professor, PhD Christian Lindholst, Department of Politics and Society, Aalborg University, Denmark

Associate Professor Randi Eikeland, Department of Health and Nursing Sciences, University of Agder, is appointed as the administrator for the assessment committee.

Supervisors in the doctoral work were Professor Dag Olaf Torjesen, Department of Political Science and Management, University of Agder (main supervisor) and Associate Professor Tor-Ivar Karlsen, Department of Psychososial Health, University of Agder (co-supervisor)

What to do as an online audience member:

The disputation is open to the public, but to follow the trial lecture and the public defence digitally, transmitted via the Zoom conferencing app, you have to register as an audience member on this link:

https://uiano.zoom.us/meeting/register/u50lfu6urDorG9BIh5X1YdmtJbAtKmbfInMf

A Zoom-link will be returned to you. (Here are introductions for how to use Zoom: support.zoom.us if you cannot join by clicking on the link.)

We ask online audience members to join the virtual trial lecture at 09:05 at the earliest and the public defense at 11:20 at the earliest. After these times, you can leave and rejoin the meeting at any time. Further, we ask online audience members to turn off their microphone and camera and keep them turned off throughout the event. You do this at the bottom left of the image when in Zoom. We recommend you use ‘Speaker view’. You select that at the top right corner of the video window when in Zoom.

Opponent ex auditorio:

The chair invites members of the public to pose questions ex auditorio in the introduction to the public defense. Deadline is during the break between the two opponents. The person asking questions should have read the thesis. For online audience the Contact Persons e-mail are available in the chat function during the Public Defense, and questions ex auditorio can be submitted to Eli Margareth Andås on e-mail eli.andas@uia.no.