AUSTIN, Texas — Female workers injured on the job are more likely to qualify for workers’ compensation disability payments and to receive higher payment amounts when their claims are evaluated by female doctors, according to a new study from economics researchers at The University of Texas at Austin and the University of Illinois at Chicago. Their work provides the first evidence that a doctor’s gender could be a significant factor in gender disparities observed in medical evaluations.
The study, released in the National Bureau of Economic Research working paper series, analyzed administrative data from the Texas workers’ compensation system from the years 2013 through 2017. The authors focused on the dispute resolution process of workers’ compensation insurance claims. Dispute resolution medical evaluations occur when one party – most often the insurer – disagrees with the assessment of the initial evaluating doctor. In such cases, an independent second opinion is obtained from a randomly assigned doctor. Patients have no control over the gender of the designated doctor who will decide their claim.
The results showed that female claimants were 5% more likely to be evaluated as disabled and received about 8.5% more in cash benefits when the doctor assigned to their claim was female rather than male. No comparable effect was found for injured male workers, whose benefits were the same regardless of the gender of the doctor assessing their claim.
The authors also reviewed a broader data set of all workers’ compensation claims in Texas during the same period, including cases in which patients were allowed to select their evaluating doctors, and found that female workers overall received cash benefits at a substantially lower rate than male workers with comparable conditions.
The authors note that the effect of doctor gender match on the outcomes of female patients is large enough that addressing this single issue could considerably close the gender gap in injury compensation.
“A growing body of research documents large disparities between male and female patients in health care and in social insurance benefits that rely on medical evaluations. However, it is not clear what drives these disparities,” said study co-author Marika Cabral, an associate professor of economics at UT Austin. “Our study indicates that doctors’ gender is an important factor in the evaluation of female patients, which suggests that the disparities are not entirely driven by underlying health differences between male and female patients.”
To explore possible mechanisms driving these outcomes, the authors also conducted a survey of 1,519 adults between the ages of 30 and 64 who had worked during the past 12 months. Among the respondents, women reported negative experiences with doctors more often than men and expressed a greater preference for doctors of the same gender.
“Relative to men, women were much more likely to report that an own-gender doctor would be more likely to treat them with respect, understand their concerns, believe them, provide needed testing and treatments, make them feel comfortable and ask appropriate questions instead of making assumptions,” said co-author Marcus Dillender, an assistant professor at the University of Illinois at Chicago.
The authors suggest two types of policy interventions aimed at closing the gender gap in health care outcomes that rely on doctors as gatekeepers. The first are policies that would increase the number of female doctors. Although the proportion of women in the physician workforce has been steadily climbing, nearly two-thirds of practicing physicians are male. The authors estimate that improving gender balance among designated doctors in the dispute resolution process could close 39.8% of the observed gender gap in compensation for female workers.
A second, and more immediate, policy intervention would be changing the random assignment of designated doctors from the current gender-blind system to one that matches doctor gender to that of the claimant when possible.
Because no effects on compensation due to doctor gender were observed for male patients, such policies could improve outcomes for women without detrimental impact on their male counterparts.