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Bismarck's Health Insurance and the Mortality Decline

Author

Listed:
  • 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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    3. Becker, Sascha O. & Hornung, Erik, 2020. "The Political Economy of the Prussian Three-Class Franchise," The Journal of Economic History, Cambridge University Press, vol. 80(4), pages 1143-1188, December.
    4. 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).
    5. Tommy Krieger, 2022. "Elites and Health Infrastructure Improvements in Industrializing Regimes," CESifo Working Paper Series 9808, CESifo.
    6. 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.
    7. Christine Valente & Hans H. Sievertsen & Mahesh C. Puri, 2020. "Saving Neonatal Lives for a Quarter," Bristol Economics Discussion Papers 20/728, School of Economics, University of Bristol, UK.
    8. 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.
    9. 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.
    10. Erik Hornung, 2021. "Industrialisierung im Deutschen Reich: Welche Rolle spielte die öffentliche Infrastruktur?," Wirtschaftsdienst, Springer;ZBW - Leibniz Information Centre for Economics, vol. 101(4), pages 258-262, April.
    11. 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.
    12. 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.
    13. Sonia Bhalotra & Rudi Rocha & Rodrigo R. Soares, 2019. "Does Universalization of Health Work? Evidence from Health Systems Restructuring and Expansion in Brazil," Documentos de Trabajo 17122, The Latin American and Caribbean Economic Association (LACEA).
    14. Elisabeth Bublitz & Michael Wyrwich, 2018. "Technological change and labor market integration," Jena Economics Research Papers 2018-008, Friedrich-Schiller-University Jena.
    15. 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.
    16. 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.
    17. 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).
    18. 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.
    19. 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.
    20. Tommy Krieger, 2024. "Elites and health infrastructure improvements in industrializing regimes," Journal of Economic Growth, Springer, vol. 29(3), pages 433-468, September.
    21. 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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