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According to The Camden Group, a national healthcare consultancy, staffing can make up to 55% of total costs in most healthcare systems, which is one of the major reasons that clashes like those between University of Pittsburgh Medical Center and the SEIU are likely to remain common in the future. Health systems typically have margins of less than 3% and so increased cost pressures from fewer overnight hospital stays or too slowly growing payments from Medicare, Medicaid, and other insurers cause proportionally larger pain than in the faster growth past. While federal mandate has increased technology costs, it may be nurses and non-clinical administrative personnel who feel the crunch in frozen wages, layoffs, and increased insurance and retirement costs. Of course, these extreme measures could lead to increased labor strife and organizing drives where unions are not currently present.