License to Kill? The Impact of Hospital Strikes

35 Pages Posted: 9 Jul 2019

See all articles by Eduardo Costa

Eduardo Costa

New University of Lisbon - Nova School of Business and Economics, Students

Date Written: May 20, 2019


Hospital strikes in the Portuguese National Health Service (NHS) are becoming increasingly frequent, raising concerns in what respects patient safety. In fact, data shows that hospital mortality for patients admitted during strikes increases by 10%. This paper analyses the effects of different types of hospital strikes (Physicians, Nurses and Diagnostic and Therapeutic Technicians - DTT) on patients' outcomes and hospital activity.

We use patient-level data comprising all NHS hospital admissions in mainland Portugal from 2012 to 2016, together with a comprehensive strike dataset comprising over 130 strikes. Preliminary results, controlling for hospital characteristics and changes in patients' composition, suggest an 8% increase in hospital mortality for patients exposed to physicians' strikes. No significant effect is found for nurses or DTTs' strikes. Additionally, hospital operations are partially disrupted during strikes, with a sharp reduction in surgical admissions (up to 60%) and a substitution from inpatient to outpatient care admissions. Moreover, strikes are associated with increase complications during births, and with less cesarean sections. The impact of strikes depends on the type of hospital and on patient admission characteristics. Results suggest that legal minimum staffing levels defi ned during strikes fail to prevent worse health outcomes for both new and existing patients.

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 (May 20, 2019). Available at SSRN: or

Eduardo Costa (Contact Author)

New University of Lisbon - Nova School of Business and Economics, Students ( email )


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