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Bismarck's Health Insurance and the Mortality Decline

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  • Hornung, Erik
  • Bauernschuster, Stefan
  • Driva, Anastasia

Abstract

We investigate the impact on mortality of the world's first compulsory health insurance, established by Otto von Bismarck, Chancellor of the German Empire, in 1884. Employing a multi-layered empirical setup, we draw on international comparisons and difference-in-differences strategies using Prussian administrative panel data to exploit differences in eligibility for insurance across occupations. All approaches yield a consistent pattern suggesting that Bismarck's Health Insurance generated a significant mortality reduction. The results are largely driven by a decline of deaths from infectious diseases. We present prima facie evidence that diffusion of new hygiene knowledge through physicians was an important channel.

Suggested Citation

  • Hornung, Erik & Bauernschuster, Stefan & Driva, Anastasia, 2017. "Bismarck's Health Insurance and the Mortality Decline," CEPR Discussion Papers 12200, C.E.P.R. Discussion Papers.
  • Handle: RePEc:cpr:ceprdp:12200
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    1. Sonia Bhalotra & Martin Karlsson & Therese Nilsson, 2017. "Infant Health and Longevity: Evidence from A Historical Intervention in Sweden," Journal of the European Economic Association, European Economic Association, vol. 15(5), pages 1101-1157.
    2. Philipp Ager & Casper Worm Hansen & Peter Sandholt Jensen, 2018. "Fertility and Early-Life Mortality: Evidence from Smallpox Vaccination in Sweden," Journal of the European Economic Association, European Economic Association, vol. 16(2), pages 487-521.
    3. Case, Anne & Lee, Diana & Paxson, Christina, 2008. "The income gradient in children's health: A comment on Currie, Shields and Wheatley Price," Journal of Health Economics, Elsevier, vol. 27(3), pages 801-807, May.
    4. Daron Acemoglu & Simon Johnson, 2007. "Disease and Development: The Effect of Life Expectancy on Economic Growth," Journal of Political Economy, University of Chicago Press, vol. 115(6), pages 925-985, December.
    5. Anthony Strittmatter & Uwe Sunde, 2013. "Health and economic development—evidence from the introduction of public health care," Journal of Population Economics, Springer;European Society for Population Economics, vol. 26(4), pages 1549-1584, October.
    6. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 431-466.
    7. Subramanian, Shankar & Deaton, Angus, 1996. "The Demand for Food and Calories," Journal of Political Economy, University of Chicago Press, vol. 104(1), pages 133-162, February.
    8. Kesztenbaum, Lionel & Rosenthal, Jean-Laurent, 2011. "The health cost of living in a city: The case of France at the end of the 19th century," Explorations in Economic History, Elsevier, vol. 48(2), pages 207-225, April.
    9. Peter Lorentzen & John McMillan & Romain Wacziarg, 2008. "Death and development," Journal of Economic Growth, Springer, vol. 13(2), pages 81-124, June.
    10. Timothy W. Guinnane, 2011. "The Historical Fertility Transition: A Guide for Economists," Journal of Economic Literature, American Economic Association, vol. 49(3), pages 589-614, September.
    11. Philippe Aghion & Steven Durlauf (ed.), 2014. "Handbook of Economic Growth," Handbook of Economic Growth, Elsevier, edition 1, volume 2, number 2.
    12. David Cutler & Angus Deaton & Adriana Lleras-Muney, 2006. "The Determinants of Mortality," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 97-120, Summer.
    13. Marcella Alsan & Claudia Goldin, 2019. "Watersheds in Child Mortality: The Role of Effective Water and Sewerage Infrastructure, 1880–1920," Journal of Political Economy, University of Chicago Press, vol. 127(2), pages 586-638.
    14. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    15. Broadberry,Stephen & O'Rourke,Kevin H., 2010. "The Cambridge Economic History of Modern Europe," Cambridge Books, Cambridge University Press, number 9780521708395.
    16. Meeker, Edward, 1974. "The Social Rate of Return on Investment in Public Health, 1880–1910," The Journal of Economic History, Cambridge University Press, vol. 34(2), pages 392-421, June.
    17. Quamrul H. Ashraf & Ashley Lester & David N. Weil, 2009. "When Does Improving Health Raise GDP?," NBER Chapters, in: NBER Macroeconomics Annual 2008, Volume 23, pages 157-204, National Bureau of Economic Research, Inc.
    18. Dora L. Costa, 2015. "Health and the Economy in the United States from 1750 to the Present," Journal of Economic Literature, American Economic Association, vol. 53(3), pages 503-570, September.
    19. Bowblis, John R., 2010. "The Decline in Infant Death Rates, 1878–1913: The Role of Early Sickness Insurance Programs," The Journal of Economic History, Cambridge University Press, vol. 70(01), pages 221-232, March.
    20. Amy Finkelstein, 2007. "The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare," The Quarterly Journal of Economics, Oxford University Press, vol. 122(1), pages 1-37.
    21. Seema Jayachandran & Adriana Lleras-Muney, 2009. "Life Expectancy and Human Capital Investments: Evidence from Maternal Mortality Declines," The Quarterly Journal of Economics, Oxford University Press, vol. 124(1), pages 349-397.
    22. Aline Bütikofer & Katrine V. Løken & Kjell G. Salvanes, 2019. "Infant Health Care and Long-Term Outcomes," The Review of Economics and Statistics, MIT Press, vol. 101(2), pages 341-354, May.
    23. Beach, Brian & Ferrie, Joseph & Saavedra, Martin & Troesken, Werner, 2016. "Typhoid Fever, Water Quality, and Human Capital Formation," The Journal of Economic History, Cambridge University Press, vol. 76(1), pages 41-75, March.
    24. Casper Worm Hansen & Lars Lønstrup, 2015. "The Rise in Life Expectancy and Economic Growth in the 20th Century," Economic Journal, Royal Economic Society, vol. 0(584), pages 838-852, May.
    25. Kota Ogasawara & Genya Kobayashi, 2015. "The impact of social workers on infant mortality in inter-war Tokyo: Bayesian dynamic panel quantile regression with endogenous variables," Cliometrica, Journal of Historical Economics and Econometric History, Association Française de Cliométrie (AFC), vol. 9(1), pages 97-130, January.
    26. Winegarden, C. R. & Murray, John E., 1998. "The Contributions of Early Health-Insurance Programs to Mortality Declines in Pre-World War I Europe: Evidence from Fixed-Effects Models," Explorations in Economic History, Elsevier, vol. 35(4), pages 431-446, October.
    27. David Cutler & Grant Miller, 2005. "The role of public health improvements in health advances: The twentieth-century United States," Demography, Springer;Population Association of America (PAA), vol. 42(1), pages 1-22, February.
    28. Easterlin, Richard A., 1999. "How beneficent is the market? A look at the modern history of mortality," European Review of Economic History, Cambridge University Press, vol. 3(3), pages 257-294, December.
    29. Douglas Almond & Janet Currie, 2011. "Killing Me Softly: The Fetal Origins Hypothesis," Journal of Economic Perspectives, American Economic Association, vol. 25(3), pages 153-172, Summer.
    30. Brown, John C., 1988. "Coping with Crisis? The Diffusion of Waterworks in Late Nineteenth-Century German Towns," The Journal of Economic History, Cambridge University Press, vol. 48(2), pages 307-318, June.
    31. Casper Worm Hansen & Peter Sandholt Jensen & Peter Egedesø Madsen, 2016. "Information and Disease Prevention: Tuberculosis Dispensaries," Discussion Papers 16-01, University of Copenhagen. Department of Economics.
    32. Hoyt Bleakley, 2007. "Disease and Development: Evidence from Hookworm Eradication in the American South," The Quarterly Journal of Economics, Oxford University Press, vol. 122(1), pages 73-117.
    33. Mokyr, Joel, 2000. "Why “More Work for Mother?†Knowledge and Household Behavior, 1870–1945," The Journal of Economic History, Cambridge University Press, vol. 60(1), pages 1-41, March.
    34. Ferrie, Joseph P. & Troesken, Werner, 2008. "Water and Chicago's mortality transition, 1850-1925," Explorations in Economic History, Elsevier, vol. 45(1), pages 1-16, January.
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    Cited by:

    1. 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.
    2. 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.
    3. 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.
    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. 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).
    7. 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.
    8. 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.
    9. Davide Cantoni & Noam Yuchtman, 2020. "Historical Natural Experiments: Bridging Economics and Economic History," NBER Working Papers 26754, National Bureau of Economic Research, Inc.
    10. Gregori Galofré-Vilà & Martin McKee & David Stuckler, 2022. "Quantifying the mortality impact of the 1935 old-age assistance," European Review of Economic History, Oxford University Press, vol. 26(1), pages 62-77.
    11. 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.
    12. 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.
    13. 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.
    14. 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.
    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. Tommy Krieger, 2022. "Elites and Health Infrastructure Improvements in Industrializing Regimes," CESifo Working Paper Series 9808, CESifo.
    17. 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.
    18. 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; Prussian economic history;
    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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