Collective Bargaining and Technological Investment: The Case of Nurses’ Unions and the Transition from Paper‐Based to Electronic Health Records
研究美国医院中注册护士工会化是否阻碍了从纸质病历向电子健康记录的转型，发现工会化医院更可能推迟转型，但这一关系受医院患者结构影响，在服务弱势群体的医院中工会反而促进电子病历采纳。
Abstract Does the presence of a unionized nursing workforce retard US hospitals’ transition from paper‐based to electronic health records (EHRs)? After tying archival data on hospitals’ structural features and health information technology (IT) investment patterns to self‐gathered data on unionism, I find that hospitals that bargain collectively with their registered nurses (RNs) appear to delay or forego the transition away from paper, consistent with existing theory and research in industrial relations and institutional economics. However, this relationship is fully mediated by a hospital's payer mix: those serving a larger share of less lucrative, elderly, disabled and indigent patients are more likely to adopt EHRs if they are unionized than if they are not, a result that holds even at the median payer mix. Indeed, this accords with research on the interplay of labour and technology as the aforementioned dynamics are driven entirely by RN‐exclusive bargaining units for whom the new IT serves as a complement rather than as a substitute in production. Given the outsized role that unions play in the US healthcare sector, the overall sluggish performance of the sector, and the expectations that policymakers have for EHRs, evidence that these unions are welfare‐enhancing should be welcome news.