Bismarck’s Health Insurance and the Mortality Decline

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...

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Bibliographic Details
Published in:Journal of the European Economic Association 2020-10, Vol.18 (5), p.2561-2607
Main Authors: Bauernschuster, Stefan, Driva, Anastasia, Hornung, Erik
Format: Article
Language:English
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Summary: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.
ISSN:1542-4766
1542-4774
DOI:10.1093/jeea/jvz052