Passive representation and the client-bureaucrat relationship: communication and demand inducement in the patient-provider relationship

Abstract

The ways that passive representation could produce substantive benefits for the clients of a bureaucracy irrespective of active representation are an understudied aspect of the theory of representative bureaucracy. Further, the use of data that exist at the aggregate-level has precluded researchers from being able to identify the source of benefits that they aim to identify. Two possible ways that passive representation could produce benefits are better communication between the client and the bureaucrat and demand inducement, the latter of which increases the likelihood that clients will utilize the services that the bureaucracy or the bureaucrat provides. This study empirically examines these two sources of benefits using client-level data of the patient-provider relationship. It is found that passive representation can result in better communication and can induce demand, but under certain conditions. Past discrimination, the client's personal need for services, and institutional structure influence whether or not passive representation has an impact on the client-bureaucrat relationship.