336/2017 Stefan Bauernschuster, Anastasia Driva, and Erik Hornung

We investigate the impact on mortality of the world's rst 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.

Economic History

Journal of the European Economic Association

https://doi.org/10.1093/jeea/jvz052