The Contributions of Early Health-Insurance Programs to Mortality Declines in Pre-World War I Europe: Evidence from Fixed-Effects Models

The causes of the historical decline in European mortality rates are still vigorously debated. Our contribution is to examine a previously neglected aspect, the role of the early government-sponsored health-insurance programs in widening access to medical care. We construct and test fixed-effect models of mortality rates, using data for a panel of five European countries over the 1878–1913 period. After diagnostic tests of our results, we conclude that the expanding population coverage of these health-insurance programs contributed significantly to the observed declines in mortality.