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

Abstract

Abstract 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.

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