Bismarck’s Health Insurance and the Mortality Decline

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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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Most cited references 67

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The Determinants of Mortality

David Cutler, Angus Deaton, Adriana Lleras-Muney (2006)

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Disease and Development: Evidence from Hookworm Eradication in the American South.

Hoyt Bleakley (2007)

This study evaluates the economic consequences of the successful eradication of hookworm disease from the American South. The hookworm-eradication campaign (c. 1910) began soon after (i) the discovery that a variety of health problems among Southerners could be attributed to the disease and (ii) the donation by John D. Rockefeller of a substantial sum to the effort. The Rockefeller Sanitary Commission (RSC) surveyed infection rates in the affected areas (eleven southern states) and found that an average of forty percent of school-aged children were infected with hookworm. The RSC then sponsored treatment and education campaigns across the region. Follow-up studies indicate that this campaign substantially reduced hookworm disease almost immediately. The sudden introduction of this treatment combines with the cross-area differences in pre-treatment infection rates to form the basis of the identification strategy. Areas with higher levels of hookworm infection prior to the RSC experienced greater increases in school enrollment, attendance, and literacy after the intervention. This result is robust to controlling for a variety of alternative factors, including differential trends across areas, changing crop prices, shifts in certain educational and health policies, and the effect of malaria eradication. No significant contemporaneous results are found for adults, who should have benefited less from the intervention owing to their substantially lower (prior) infection rates. A long-term follow-up of affected cohorts indicates a substantial gain in income that coincided with exposure to hookworm eradication. I also find evidence that eradication increased the return to schooling.

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Did Unilateral Divorce Laws Raise Divorce Rates? A Reconciliation and New Results

Justin Wolfers (2006)

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Author and article information

Journal

Title: Journal of the European Economic Association

Publisher: Oxford University Press (OUP)

ISSN (Print): 1542-4766

ISSN (Electronic): 1542-4774

Publication date Created: October 10 2019

Publication date (Electronic): October 10 2019

Affiliations

[1 ]University of Passau

[2 ]LMU Munich

[3 ]University of Cologne

Article

DOI: 10.1093/jeea/jvz052

SO-VID: e9cd0aa2-0a6e-40e0-85c6-5969a50d7a49

License:

https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

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