Representation and high-risk clients: an empirical examination of gender effects in healthcare
利用佛罗里达医院的患者数据，研究性别代表性如何影响产科护理结果，发现女医生对女患者有更好效果，且高风险（35岁及以上）患者受益更大。
The representative bureaucracy literature explores various effects of shared identity between clients and bureaucrats. Recent studies examine different types of representation, the transition between these types of representation, and the conditions that enhance representation effects. Although much of the research in this area explores factors at the organizational and institutional levels, less attention has been paid to how a client’s needs or vulnerabilities influence representation effects. Using individual-level inpatient data from Florida hospitals, this study examines how gender representation influences outcomes of obstetric care and, importantly, how a client’s risk level moderates the effects of gender representation. The results show that female patients experience better outcomes when they receive obstetric care from female physicians. Moreover, these positive effects of gender representation are enhanced when clients are at higher risk (at or over 35 years of age). Implications of these findings for representative bureaucracy theory, as well as healthcare administration and street-level bureaucracy, are discussed.