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The 'cultural inflation of morbidity' during the English mortality decline: a new look.

机译:英国死亡率下降期间的“发病率的文化膨胀”:一种新外观。

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This article contributes to the debate about using insurance records to reconstruct historical experiences of sickness during the Western mortality transition. Critics regard these sources as problematic as they measure morbidity indirectly through absences from work; these might be determined not by timeless biological criteria but by more contingent factors, notably shifting norms surrounding the sick role and responses to economic incentives (for which we adopt the generic term 'cultural inflation of morbidity'). We review historical demographers' contributions to this literature and discuss the concepts of moral hazard and the principal/agent problem as developed by health economists. This leads us to frame three empirical tests for 'cultural inflation' which allow us to assess the validity of insurance records for deriving morbidity trends: was there an increasing frequency of claims for complaints of diminishing severity; were unduly prolonged claims noticeable, particularly by older people for whom sickness benefit may have compensated for income insecurity; and did the insurer satisfactorily manage the agency problem to ensure reliable physician gatekeeping? We analyse records of the Hampshire Friendly Society, an exceptionally well-documented fund operational in Southern England, 1825-1989. Findings are based on a dataset of individual sickness histories of a sample of 5552 men and on qualitative documentary analysis of administrative records. On each count our results fail to demonstrate a cultural inflation of morbidity, except perhaps for those aged over 65. However, occasional discussion in the administrative records of economic incentives encouraging unnecessary prolongation of claims means we cannot rule it out entirely.
机译:本文为有关使用保险记录来重建西方死亡率过渡期间疾病历史经验的辩论做出了贡献。评论家认为这些来源是有问题的,因为它们通过缺勤间接测量发病率。这些可能不是由永恒的生物学标准决定的,而是由更偶然的因素决定的,尤其是围绕病态角色的规范变化和对经济激励措施的反应(为此,我们采用“发病率的文化膨胀”这一通称)。我们回顾了历史人口统计学家对该文献的贡献,并讨论了由卫生经济学家提出的道德风险和委托/代理问题的概念。这导致我们对“文化通货膨胀”进行了三个实证检验,使我们能够评估保险记录对推导发病率趋势的有效性:是否对严重程度下降的投诉的索赔频率增加了;过度延长的索赔要求引人注目,尤其是对于老年人而言,他们的疾病补助可能已补偿了收入的不安全感;保险公司是否令人满意地管理了代理问题,以确保可靠的医生看护?我们分析了1825-1989年在英格兰南部运作的,有据可查的基金汉普郡友好协会的记录。调查结果基于5552名男性样本的个人疾病史数据集以及对行政记录的定性文献分析。从每个方面来看,我们的结果都不能证明发病率在文化上有所膨胀,也许对于65岁以上的人除外。但是,行政记录中偶尔会讨论鼓励不必要地延长索赔期限的经济激励措施,这意味着我们不能完全排除这种情况。

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