Department of Public Administration and Policy PhD student Austin McCrea recently published an article in Public Administration Review that examined whether women’s health outcomes improve when treated by a physician of the same gender – and how that connection is affected by patient insurance status.

“The Cost of Representation: Insurance Status, Gender, and Cardiac Outcome Emergency Department Care,” posted online January 28, will appear in a forthcoming print issue of the journal.

McCrea, whose research focuses on institutional constraints to good healthcare outcomes, transferred to American University two years ago to continue working with Ken Meier, now a distinguished scholar in residence at SPA. McCrea became intrigued with representation in women’s health after reading a study that showed women who were treated by female physicians were less likely to die from heart attack episodes than those treated by men.

Based on data on individual-level emergency department visits to Florida hospitals, his results revealed that public insurance status – whether the patient used Medicaid or Medicare – did not negate the benefits of same-sex care, but a lack of insurance did. Women without insurance did not see improved outcomes, specifically heart attack mortality, when receiving representation.

McCrea chose the ER to test his theory, which touches on issues of inequity and diversity, because of the high-risk, time-critical nature of the environment. While patients are not turned away for inability to pay, payment incentive structures can impact quality of care. McCrea noted that the study’s findings are not a condemnation of representation or front-line healthcare workers, but rather reflect a nuanced view of how an organization’s regulatory structure and lack of a good compensation system create inequitable outcomes.

“We really need to think about a new model for reimbursement and compensation, because the structures fall disproportionately on the most vulnerable and needy populations in society,” said McCrea.

McCrea hopes the results catch the attention of academics studying representative bureaucracy and policy makers looking to improve healthcare.

“If we care about designing better systems and more equitable organizations, it’s incumbent on us as scholars to ask tough questions,” he continued. “We need to identify areas that aren’t working, or where there are administrative failures. If we don’t know where things fail, how are we going to be able to make improvements? This has academic and practical implications.”

McCrea, who will graduate in May and plans a career in academia, incorporated the research from this paper into his dissertation.