Cost Implications of Hospital Unionization: A Behavioral Analysis

37 Pages Posted: 7 Apr 2004 Last revised: 4 Aug 2010

Date Written: July 1982


The growth of unionization among hospital workers was sharply accelerated by the 1974 amendments to the NLRA covering voluntary hospital workers. With continuing inflationary pressures in the hospital sector, the cost implications of the recent and projected growth of hospital unions is of some concern to policy-makers . This paper presents estimates of union cost impacts based on data from hospitals in the states of Maryland, Massachusetts, New York, and Pennsylvania. Cross-sectional regressions with data for 1975 yield positive union impacts of 3.3 percent on total costs, 4.1 to 5.9 percent on cost per case, and 6.1 percent on cost per day. Re-estimation of the model with data on changes over the 1971 -75 period yields similar results. We also find that the cost impact of unionization varies with the pattern of coverage (being lower for service employees and RN's) and with the extent of cost-based reimbursement. This suggests that future cost impacts of union growth may be moderated as prospective payment systems for hospital s become more widespread.

Suggested Citation

Salkever, David S., Cost Implications of Hospital Unionization: A Behavioral Analysis (July 1982). NBER Working Paper No. w0946. Available at SSRN:

David S. Salkever (Contact Author)

UMBC, Department of Public Policy ( email )

1000 Hilltop Circle
Baltimore, MD 21250

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