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Social Insurance and Health

Health Econometrics

ISBN: 978-1-78714-542-9, eISBN: 978-1-78714-541-2

ISSN: 0573-8555

Publication date: 30 May 2018


This chapter reviews the existing empirical evidence on how social insurance affects health. Social insurance encompasses programs primarily designed to insure against health risks, such as health insurance, sick leave insurance, accident insurance, long-term care insurance, and disability insurance as well as other programs, such as unemployment insurance, pension insurance, and country-specific social insurance programs. These insurance systems exist in almost all developed countries around the world. This chapter discusses the state-of-the art evidence on each of these social insurance systems, briefly reviews the empirical methods for identifying causal effects, and examines possible limitations to these methods. The findings reveal robust and rich evidence on first-stage behavioral responses (“moral hazard”) to changes in insurance coverage. Surprisingly, evidence on how changes in coverage impact beneficiaries’ health is scant and inconclusive. This lack of identified causal health effects is directly related to limitations on how human health is typically measured, limitations on the empirical approaches, and a paucity of administrative panel data spanning long-time horizons. Future research must be conducted to fill these gaps. Of particular importance is evidence on how these social insurance systems interact and affect human health over the life cycle.




I thank Maria Fitzpatrick, Pauline Leung, Zhuan Pei, Stefan Pichler, Sarah Prenovitz, Julian Reif, Hendrik Schmitz, and two anonymous referees for excellent comments on a previous draft of this chapter. I also thank Beining Niu for excellent research assistance. I take responsibility for all remaining errors in and shortcomings of the chapter. The research reported in this chapter is not the result of a for-pay consulting relationship. Cornell does not have a financial interest in the topic of the chapter which might constitute a conflict of interest.


Ziebarth, N.R. (2018), "Social Insurance and Health", Health Econometrics (Contributions to Economic Analysis, Vol. 294), Emerald Publishing Limited, Bingley, pp. 57-84.



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