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Bismarck’s Health Insurance and the Mortality Decline
[Disease and Development: The Effect of Life Expectancy on Economic Growth]

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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 difference-in-differences and regional fixed effects 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. Further evidence suggests that statutory access to well-trained doctors was an elementary channel. This finding may be explained by insurance fund physicians transmitting new knowledge on infectious disease prevention.

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  • Stefan Bauernschuster & Anastasia Driva & Erik Hornung, 2020. "Bismarck’s Health Insurance and the Mortality Decline [Disease and Development: The Effect of Life Expectancy on Economic Growth]," Journal of the European Economic Association, European Economic Association, vol. 18(5), pages 2561-2607.
    • Handle: RePEc:oup:jeurec:v:18:y:2020:i:5:p:2561-2607.
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    File URL: http://hdl.handle.net/10.1093/jeea/jvz052
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    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. Tommy Krieger, 2024. "Elites and health infrastructure improvements in industrializing regimes," Journal of Economic Growth, Springer, vol. 29(3), pages 433-468, September.
    14. 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.
    15. 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.
    16. 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.
    17. 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).
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    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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