Some municipalities have outsourced their medical services because of a labor shortage in medical doctors. Now a big private company produces all the medical services to the residents in some cities. Outsourcing has produced more efficiency, not necessarily cost savings. Municipal decision makers have mostly been satisfied with outsourcing. It has renewed the ways of acting and brought cost consciousness along with it. It has also enhanced the thinking that municipalities have to rearrange their duties and deliberate upon the services which can be outsourced. (Kuntalehti 10/2005, 11/2005, Kuntaliitto 2005.)