Nevertheless, productivity of hospitals has been declining since the late 1990s, and large regional differences remain in efficiency, cost and outcomes (Aaltonen, 2007, Hakkinen, 2010). The average length of stay in hospitals is long for most conditions (OECD, 2010b). Municipalities tend to complain about difficulties in controlling costs because of the asymmetry of information between hospitals and them, as well as standards fixed at the national level (OECD, 2005).