License to Kill? The Impact of Hospital Strikes

35 Pages Posted: 9 Jul 2019 Last revised: 1 Oct 2020

See all articles by Eduardo Costa

Eduardo Costa

Nova School of Business and Economics

Date Written: October 1, 2020


Hospital strikes in the Portuguese National Health Service (NHS) are becoming increasingly frequent. This paper analyses the effect of different health professionals' strikes (physicians, nurses and diagnostic and therapeutic technicians - DTT) on patients’ outcomes and hospital activity. Patient-level data, comprising all NHS hospital admissions in mainland Portugal from 2012 to 2018, is used together with a comprehensive strike dataset with almost 130 protests. Pooled OLS is employed to study the impact of strikes on health outcomes. A Hazard model is also used to analyze changes in patients' length of stay. Data suggests that hospital operations are partially disrupted during strikes, with sharp reductions in surgical admissions (up to 54%) and a decline on both inpatient and outpatient care admissions. Controlling for hospital characteristics, time and regional patterns, and differences in patients’ composition, results suggest a 6% increase in hospital mortality for patients exposed to physicians’ strikes. Urgent readmissions increase for patients exposed to nurses or DTTs' strikes. Results suggest that legal minimum staffing levels defined during strikes, particularly during physicians' strikes, fail to prevent declines in the quality of care provided.

Keywords: healthcare strikes, hospital mortality, readmission, length of stay

JEL Classification: J52, I11, I12, I18

Suggested Citation

Costa, Eduardo, License to Kill? The Impact of Hospital Strikes (October 1, 2020). Available at SSRN: or

Eduardo Costa (Contact Author)

Nova School of Business and Economics ( email )

Campus de Carcavelos
Rua da Holanda, 1
Carcavelos, 2775-405

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