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The ‘cultural inflation of morbidity’ during the English mortality decline: A new look

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  • Gorsky, Martin
  • Guntupalli, Aravinda
  • Harris, Bernard
  • Hinde, Andrew

Abstract

This article contributes to the debate about using insurance records to reconstruct historical experiences of sickness during the Western mortality transition. Critics regard these sources as problematic as they measure morbidity indirectly through absences from work; these might be determined not by timeless biological criteria but by more contingent factors, notably shifting norms surrounding the sick role and responses to economic incentives (for which we adopt the generic term ‘cultural inflation of morbidity’). We review historical demographers’ contributions to this literature and discuss the concepts of moral hazard and the principal/agent problem as developed by health economists. This leads us to frame three empirical tests for ‘cultural inflation’ which allow us to assess the validity of insurance records for deriving morbidity trends: was there an increasing frequency of claims for complaints of diminishing severity; were unduly prolonged claims noticeable, particularly by older people for whom sickness benefit may have compensated for income insecurity; and did the insurer satisfactorily manage the agency problem to ensure reliable physician gatekeeping? We analyse records of the Hampshire Friendly Society, an exceptionally well-documented fund operational in Southern England, 1825–1989. Findings are based on a dataset of individual sickness histories of a sample of 5552 men and on qualitative documentary analysis of administrative records. On each count our results fail to demonstrate a cultural inflation of morbidity, except perhaps for those aged over 65. However, occasional discussion in the administrative records of economic incentives encouraging unnecessary prolongation of claims means we cannot rule it out entirely.

Suggested Citation

  • Gorsky, Martin & Guntupalli, Aravinda & Harris, Bernard & Hinde, Andrew, 2011. "The ‘cultural inflation of morbidity’ during the English mortality decline: A new look," Social Science & Medicine, Elsevier, vol. 73(12), pages 1775-1783.
  • Handle: RePEc:eee:socmed:v:73:y:2011:i:12:p:1775-1783
    DOI: 10.1016/j.socscimed.2011.09.028
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    References listed on IDEAS

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    1. Joseph Eisenhauer, 2006. "Severity of illness and the welfare effects of moral hazard," International Journal of Health Economics and Management, Springer, vol. 6(4), pages 290-299, December.
    2. Bernard Harris & Martin Gorsky & Aravinda Meera Guntupalli & Andrew Hinde, 2012. "Long‐term changes in sickness and health: further evidence from the Hampshire Friendly Society," Economic History Review, Economic History Society, vol. 65(2), pages 719-745, May.
    3. Nyman, John A., 1999. "The economics of moral hazard revisited," Journal of Health Economics, Elsevier, vol. 18(6), pages 811-824, December.
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