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Bismarck's Health Insurance and the Mortality Decline

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

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

  • Bauernschuster, Stefan & Driva, Anastasia & Hornung, Erik, 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. 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.
    5. 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.
    6. 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.
    7. 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.
    8. Peter Lorentzen & John McMillan & Romain Wacziarg, 2008. "Death and development," Journal of Economic Growth, Springer, vol. 13(2), pages 81-124, June.
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. Broadberry,Stephen & O'Rourke,Kevin H., 2010. "The Cambridge Economic History of Modern Europe," Cambridge Books, Cambridge University Press, number 9780521708395, December.
    14. 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.
    15. 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.
    16. 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.
    17. 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.
    18. 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.
    19. 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.
    20. 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.
    21. 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.
    22. 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. Davide Cantoni & Noam Yuchtman, 2020. "Historical Natural Experiments: Bridging Economics and Economic History," NBER Working Papers 26754, National Bureau of Economic Research, Inc.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    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. Elisabeth Bublitz & Michael Wyrwich, 2018. "Technological change and labor market integration," Jena Economic Research Papers 2018-008, Friedrich-Schiller-University Jena.
    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. Franke, Richard, 2021. "Poverty, pollution, and mortality: The 1918 influenza pandemic in a developing German economy," MPRA Paper 107570, University Library of Munich, Germany.
    11. 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.

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    More about this item

    Keywords

    demographic transition; Health Insurance; Mortality; 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
    • J11 - Labor and Demographic Economics - - Demographic Economics - - - Demographic Trends, Macroeconomic Effects, and Forecasts
    • N33 - Economic History - - Labor and Consumers, Demography, Education, Health, Welfare, Income, Wealth, Religion, and Philanthropy - - - Europe: Pre-1913

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