An Application of the Theory of Representative Bureaucracy, Gender Concordance, and Symbolic Representation in the Health Care Context

Although the United States spends more on health care than comparable nations, many Americans suffer from poor health. Many factors are emphasized as being important for improved health outcomes, including social and economic indicators, living and working conditions, and individual-level behavior. However, I argue the overwhelming attention to male health outcomes—compared to female health outcomes—and focus on factors that are “traditionally understood” as important in shaping health are two limitations of existing health-related research. I adopt an innovative approach that combines the theory of representative bureaucracy, gender concordance, and symbolic representation to argue that increase in female physicians contribute to improved female health outcomes. Using an originally collected dataset that contains information on female physicians, health outcomes, and state and individual-level factors, I study how female physicians influence the health outcomes of non-Hispanic White women, non-Hispanic Black women, and Latinas in the United States from 2000 to 2012. The findings suggest female physicians contribute to improved health outcomes for non-Hispanic White women and non-Hispanic Black women, but not Latinas. Supplemental Analysis bolsters confidence that the findings are not the result of increased access to health care professionals. This study highlights the importance of applying the theory of representative bureaucracy and symbolic representation to health care, the promise of greater female representation in health, and the insight gleaned from incorporating intersectionality in public administration research.

尽管美国在医疗保健方面的支出比类似国家多，但许多美国人健康状况不佳。许多因素被强调对改善健康结果很重要，包括社会和经济指标、生活和工作条件以及个人层面的行为。然而，我认为，与女性健康结果相比，对男性健康结果的过度关注，以及侧重于那些“传统上被认为”对健康有重要影响的因素，是现有健康相关研究的两个局限。我采用一种创新方法，将代表性官僚制理论、性别一致性和象征代表理论相结合，认为女医生数量的增加有助于改善女性健康结果。利用一个原始收集的数据集，其中包含女医生、健康结果以及州和个人层面因素的信息，我研究了2000年至2012年期间女医生如何影响美国非西班牙裔白人女性、非西班牙裔黑人女性和拉丁裔女性的健康结果。研究结果表明，女医生有助于改善非西班牙裔白人女性和非西班牙裔黑人女性的健康结果，但对拉丁裔女性没有帮助。补充分析增强了人们的信心，即研究结果并非是更容易获得医疗保健专业人员服务的结果。这项研究强调了将代表性官僚制理论和象征代表理论应用于医疗保健的重要性、女性在医疗领域有更多代表的前景，以及在公共行政研究中纳入交叉性所获得的见解。