Representation and high-risk clients
An empirical examination of gender effects in healthcare
Bibliographic Data
| ID | 22421130 |
|---|---|
| Authors | Xiaoyang Xu (0000-0002-5970-1739, University of South Carolina, corresponding author) |
| Year | 2026 |
| Pages | 1-47 |
| Publication date | 2026-05-27 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | International Public Management Journal (JOURNAL) |
| Journal identifiers | ISSN: 1096-7494 • E-ISSN: 1559-3169 |
| Publisher | Informa UK Limited (PUBLISHER • GB) |
| DOI | 10.1080/10967494.2026.2614680 |
| OpenAlex | W7162520430 |
| Language | EN |
| References cited | 90 |
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.
Empirical examination · Empirical research · Health care · Public healthcare · Gender Diversity and Inequality · Social Power and Status Dynamics · Workplace Violence and Bullying
The individual level effect of symbolic representation
Co-Production and Co-Creation
Physician–patient racial concordance and disparities in birthing mortality for newborns
Physician Gender Effects in Medical Communication
Separating symbolic and active representation
Association of Prenatal Care Services, Maternal Morbidity, and Perinatal Mortality With the Advanced Maternal Age Cutoff of 35 Years
Theoretical Frontiers in Representative Bureaucracy
Adverse Birth Outcomes Among Women of Advanced Maternal Age With and Without Health Conditions in Maryland
Too much too young”
Gender Representation and Student Performance
Representative Bureaucracy
Representative Bureaucracy Through Staff With Lived Experience
Ambition Is Priceless
An Application of the Theory of Representative Bureaucracy, Gender Concordance, and Symbolic Representation in the Health Care Context
Representative Bureaucracy, Environmental Turbulence, and Organizational Performance
Representative Bureaucracy, Institutional Support, and Clientele Need
Unraveling Representative Bureaucracy
Expanding the theoretical boundaries of active representation
Representative bureaucracy and the policy environment
The Individual‐Level Effect of Gender Matching in Representative Bureaucracy
Administrative Discretion and Active Representation
Representative Bureaucracy
The Cost of Representation
Bureaucracy, Democracy, and Race
Black or Blue
Race, Ethnicity, and Immigration
Race, Respect, and Red Tape
Going Beyond Reading, Writing, and Arithmetic
Race, Bureaucracy, and Symbolic Representation
Representative Bureaucracy in Policing
Linking Passive and Active Representation by Gender
Verbal analysis of doctor-patient communication
Too far to walk
Lipstick and Logarithms
Mental and physical health
| Citation velocity | historical |
|---|---|
| Highly cited | No |