Strikes and patient care

Chris Farrell From chief economics correspondent Chris Farrell

Paul is closely monitoring contract negotiations between 12,000 nurses and 6 hospital systems in the Twin Cities. There is talk of a strike, although it’s unclear how real the risk is that bargaining will actually break down before the contract ends on May 31.

Still, what is the potential impact of a hospital strike on patients? That’s the question investigated in a recent National Bureau of Economic Research (NBER) paper, Do Strikes Kill? Evidence from New York State by economists Jonathan Gruber of MIT and Samuel A. Kleiner of Carnegie Mellon. (Gruber is among the nation’s leading healthcare economists; his research is always worth reading.)

They note that concerns over patient welfare excluded hospitals from collective bargaining laws for almost three decades after other major sectors of the economy could unionize. Collective bargaining became permissible in 1974. Hospitals are now among the country’s most unionized industries.

To attempt an answer, Gruber and Kleiner gathered data on every hospital strike over the 1984 to 2004 period in New York State. They then matched that data to a hospital discharge database that provides information on treatment intensity, patient mortality and hospital readmission. They also controlled for a number of factors, such as patient demographics and disease severity.

Their results are arresting, although it’s in the nature of a limited study like theirs that the conclusions are suggestive rather than definitive. They estimate that nurses’ strikes increase in-hospital mortality by 19.4% and the 30-day readmission rate by 6.5% compared to patients admitted at nearby non-striking hospitals over the same period. The deterioration in patient care is only during the strike period. It doesn’t happen before or after the strike at the same hospital. “Overall, our findings suggest that strikes lead to lower quality of medical care in hospitals.”

The scholars are careful to say that their research focuses on the short-term negative impact of a strike on patients. They note that other research studies have shown that union-related workplace initiatives have contributed to long-run hospital productivity and the quality of care. (The paper is behind the paid subscription firewall at the NBER. I didn’t find it elsewhere. You can find the abstract here.)

The authors call for more research and, in this particular case, they’re right.

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