Social insurance claims as morbidity estimates: sickness or absence?

Historians have closely examined sickness claims by members of British friendly societies. Hoping that insurance records may offer insight into past health conditions, they have generally found that sickness rates increased as mortality rates declined. Aggregated fund level data from a variety of continental sickness insurance programmes from 1885 to 1908 cast doubt on this research strategy. Mortality rates fell among all funds with available data, but absenteeism trended in both directions in different groups of sick funds. Among funds that took in workers who were required to buy sickness insurance, absenteeism rose over time. Among funds in which membership was voluntary, absenteeism fell. To explain these differing trends, I note that voluntary funds attracted older and sicker workers and that the resulting financial problems made it difficult for them to pay out benefits. Social insurance claim records are so heavily influenced by governmental requirements and financial concerns that they may be better understood as records of worker absence rather than of morbidity.