Bismarck's Health Insurance and the Mortality Decline

2018/01/01 by Stefan Bauernschuster, Anastasia Driva, Erik Hornung · 1 citation
Economics, Econometrics and Finance · Health Professions · #Employment and Welfare Studies #Global Health Care Issues #Healthcare Systems and Reforms

paper · doi:10.1093/jeea/jvz052

openalex publication_date 2018/01/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/04

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.

Citations

• Typhoid Fever, Water Quality, and Human Capital Formation
• The Changing Relation between Mortality and level of Economic Development
• What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending
• American Attitudes toward the Germ Theory of Disease: Phyllis Allen Richmond Revisited
• When Does Improving Health Raise GDP?
• Life Expectancy and Human Capital Investments: Evidence from Maternal Mortality Declines*
• The urban sanitary movement in England and Germany, 1838–1914: a comparison
• Pensions and fertility: back to the roots

Cited by

• Otto von Bismarck [wikipedia]

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