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Bismarck's Health Insurance and the Mortality Decline

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  • Stefan Bauernschuster
  • Anastasia Driva
  • Erik Hornung

Abstract

We study the impact of social health insurance on mortality. Using the introduction of compulsory health insurance in the German Empire in 1884 as a natural experiment, we estimate flexible difference-in-differences models exploiting variation in eligibility for insurance across occupations. Our findings suggest that Bismarck’s health insurance generated a significant mortality reduction. Despite the absence of antibiotics and most vaccines, we find the results to be largely driven by a decline of deaths from infectious diseases. We present evidence suggesting that the decline is associated with access to health services but not sick pay. This finding may be explained by insurance fund physicians transmitting new knowledge on infectious disease prevention.

Suggested Citation

  • Stefan Bauernschuster & Anastasia Driva & Erik Hornung, 2017. "Bismarck's Health Insurance and the Mortality Decline," CESifo Working Paper Series 6601, CESifo.
    • Handle: RePEc:ces:ceswps:_6601
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    Cited by:

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    4. Halla, Martin & Kah, Christopher & Sausgruber, Rupert, 2021. "Testing for Ethnic Discrimination in Outpatient Health Care: Evidence from a Field Experiment in Germany," Department of Economics Working Paper Series 319, WU Vienna University of Economics and Business.
    5. Timothy W. Guinnane & Jochen Streb, 2021. "The Introduction of Bismarck's Social Security System and its Effects on Marriage and Fertility in Prussia," Population and Development Review, The Population Council, Inc., vol. 47(3), pages 749-780, September.
    6. Baten, Jörg & Batinti, Alberto & Costa-Font, Joan & Radatz, Laura, 2024. "Health insurance and height inequality: Evidence from European health insurance expansions," Socio-Economic Planning Sciences, Elsevier, vol. 93(C).
    7. Bhalotra, Sonia R. & Rocha, Rudi & Soares, Rodrigo R., 2019. "Does Universalization of Health Work? Evidence from Health Systems Restructuring and Expansion in Brazil," IZA Discussion Papers 12111, Institute of Labor Economics (IZA).
    8. Bublitz, Elisabeth & Wyrwich, Michael, 2018. "Technological change and labor market integration," WiSo-HH Working Paper Series 45, University of Hamburg, Faculty of Business, Economics and Social Sciences, WISO Research Laboratory.
    9. Sonia Bhalotra & Rudi Rocha & Rodrigo R. Soares, 2020. "Can Universalization of Health Work? Evidence from Health Systems Restructuring and Expansion in Brazil," Working Papers 03, Instituto de Estudos para Políticas de Saúde.
    10. Baten, Jörg & Batinti, Alberto & Costa-Font, Joan & Radatz, Laura, 2024. "Health insurance and height inequality: Evidence from European health insurance expansions," Socio-Economic Planning Sciences, Elsevier, vol. 93(C).
    11. Davide Cantoni & Noam Yuchtman, 2020. "Historical Natural Experiments: Bridging Economics and Economic History," NBER Working Papers 26754, National Bureau of Economic Research, Inc.
    12. Gregori Galofré-Vilà & Martin McKee & David Stuckler, 2022. "Quantifying the mortality impact of the 1935 old-age assistance," European Review of Economic History, European Historical Economics Society, vol. 26(1), pages 62-77.
    13. Richard Franke, 2022. "Poverty, pollution, and mortality: The 1918 influenza pandemic in a developing German economy," Economic History Review, Economic History Society, vol. 75(4), pages 1026-1053, November.
    14. Krieger, Tommy, 2020. "Elite structure and the provision of health-promoting public goods," ZEW Discussion Papers 20-064, ZEW - Leibniz Centre for European Economic Research.
    15. Daniel Gallardo‐Albarrán, 2020. "Sanitary infrastructures and the decline of mortality in Germany, 1877–1913," Economic History Review, Economic History Society, vol. 73(3), pages 730-757, August.
    16. Jäger, Philipp, 2023. "Can pensions save lives? Evidence from the introduction of old-age assistance in the UK," Ruhr Economic Papers 995, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    17. Martin, Lisa & Baten, Joerg, 2022. "Inequality and Life Expectancy in Africa and Asia, 1820‐2000," Journal of Economic Behavior & Organization, Elsevier, vol. 201(C), pages 40-59.
    18. Tommy Krieger, 2022. "Elites and Health Infrastructure Improvements in Industrializing Regimes," CESifo Working Paper Series 9808, CESifo.
    19. Timothy W. Guinnane & Tobias A. Jopp & Jochen Streb, 2021. "Bismarcks Sozialversicherung und ihr Einfluss auf Deutschlands demografischen Wandel," Wirtschaftsdienst, Springer;ZBW - Leibniz Information Centre for Economics, vol. 101(4), pages 262-265, April.
    20. Sharifa Ezat Wan Puteh & Azimatun Noor Aizuddin & Abdulaziz Abdullah Al Salem, 2023. "Is National Health Insurance Feasible for Saudi Healthcare Services? A Qualitative Study," International Journal of Finance, Insurance and Risk Management, International Journal of Finance, Insurance and Risk Management, vol. 13(1), pages 3-26.

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    More about this item

    Keywords

    health insurance; mortality; demographic transition; Prussia;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • N33 - Economic History - - Labor and Consumers, Demography, Education, Health, Welfare, Income, Wealth, Religion, and Philanthropy - - - Europe: Pre-1913
    • J11 - Labor and Demographic Economics - - Demographic Economics - - - Demographic Trends, Macroeconomic Effects, and Forecasts

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