The Cost of Representation: Insurance Status, Gender, and Cardiac Outcomes in Emergency Department Care

• 成果类型: Article
• 署名作者: McCrea, Austin M.
• 署名单位: American University
• 刊物名称: PUBLIC ADMINISTRATION REVIEW
• ISSN/ISSBN: 0033-3352
• DOI: 10.1111/puar.13354
• 发表日期: 2021
• 页码: 1092-1101
• 关键词: active representation; physician gender; health-care; patient gender; bureaucracy; association; CONCORDANCE; perceptions; access; IMPACT

摘要

Recent innovations in representative bureaucracy push the theory toward the micro-foundations of who represents and who receives representation. Contributing to the micro theory, I draw from street-level bureaucracy which recognizes how certain client characteristics beyond a shared identity may make representation too costly. Using data on emergency department visits to Florida hospitals, I explore how the impact of physician-patient gender matching on client outcomes is moderated by a patient's insurance status. While emergency departments offer universal, public access, services performed on publicly insured and uninsured individuals are reimbursed at a lower rate than the privately insured. These features present an opportunity to test how responsive representation is to different client costs and benefits. The findings suggest that public insurance status is not a barrier for women's representation. However, uninsured women do not see any improvement in outcomes when receiving representation.