Effects of early health-insurance programs on European mortality and fertility trends.
Effects of early health-insurance programs on European mortality and fertility trends.
复制标题
早期健康保险计划对欧洲死亡率和生育率趋势的影响。
DOI：
10.1016/s0277-9536(03)00403-9
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发表时间：
2004
影响因子：
5.4
通讯作者：
J. Murray
中科院分区：
文献类型：
--
作者：
C. R. Winegarden;J. Murray
在这项研究中，我们研究了在人口结构转型过程中，由几个欧洲政府赞助的早期医疗保险计划对死亡率和生育率的影响。三组效应被假设，并测试了五个国家的数据，涵盖1875年至1913年期间。首先，虽然最初的规模很小，但全国人口的医疗保险覆盖率不断增加，加速了死亡率的长期下降趋势。它不仅扩大了获得保健的机会，而且还有助于传播保健信息和提高认识。第二，扩大覆盖面也对生育率产生了相反的影响;通过降低生育和抚养子女的成本，它起到了减缓婚姻生育率持续下降趋势的作用。第三，在死亡率和生育率的影响之间存在着各种各样的相互作用。婴儿和儿童生存前景的改善削弱了父母生育“额外”后代的动机，以抵消死亡率的损失，并为未来的损失提供保险。生育间隔的延长和每个家庭子女的减少进一步提高了儿童存活率。然而，生育费用的降低往往会冲淡这些产前影响。我们的回归结果支持部分效应的预期模式，但需要模拟来衡量医疗保险的总体影响。进行了两组模拟：第一组是历史模拟，密切跟踪每个样本国家的实际经验;第二组是反事实模拟，在整个时间段内将医疗保险覆盖率设定为零。历史模拟和反事实模拟的比较清楚地表明，医疗保险加速了死亡率的下降趋势，但略微延缓了婚姻生育率的长期下降。在抽样国家中，这些影响的程度各不相同，但方向相同。
In this study, we examined the mortality and fertility effects of the early health-insurance programs sponsored by several European governments in the course of the demographic transition. Three sets of effects were hypothesized, and tested with data for five countries, covering the 1875–1913 period. First, although initially small, the growing health-insurance coverage of national populations accelerated longer-term downtrends in mortality. It not only expanded access to health care, but also helped in disseminating health information and awareness. Second, widening coverage also had an opposite effect on fertility; by lowering the costs of bearing and rearing children, it acted to slow the ongoing downtrend in marital fertility. Third, there was a diverse set of interactions between the mortality and fertility effects. Improved prospects for the survival of infants and children weakened parents’ motivation to produce “extra” offspring to offset losses to mortality and to insure against future losses. Child survival was further enhanced by longer intervals between births and fewer children per family. However, the reduced cost of children tended to dilute these antenatal effects. Our regression results supported the expected pattern of partial effects, but simulations were needed to gauge the total impacts of health-insurance. Two sets of simulations were conducted: first, historical simulations, which closely tracked the actual experience of each sample country; second, counterfactuals, in which health-insurance coverage was set at zero for the entire time period. Comparisons of the historical and counterfactual simulations clearly indicated that health-insurance accelerated the downtrend in mortality, but slightly retarded the secular decline in marital fertility. These effects varied in magnitude, but not in direction, among the sample countries.