Recommodification of the Social Determinants of Health

Abstract

Background
Decommodification is the extent to which living standard is independent of market position. In recent decades, some states have embarked on a process of recommodification, restricting the alternatives to participating in the market. This study has investigated how recommodification of unemployment healthcare and pensions are correlated with health inequalities.
Methods
Using Health Survey for England and the Swedish Living Conditions Survey, this study computes the magnitude of health inequalities in Sweden and England and correlates the magnitude of inequalities with measures of recommodification. In stage 1, the odds ratio of Not good health/having visited a doctor was computed using logistic regression for each year, using the employed and the high educated as the reference categories. In stage 2, the log (odds ratios) of poor health or doctor visits computed in stage 1 were correlated with the net replacement rate/price of primary care using linear regression.
Results
Health inequalities between the employed and the unemployed were significantly higher in both England and Sweden in 2011 than in 1991, a period during which unemployment benefit was recommodified in both countries. The association between health inequality and net replacement rate was much stronger in Sweden.
Health inequalities increased slightly among English pensioners, while those of the Swedish sample remained steady. This is not what we would expect from the development of recommodification in the two countries: Sweden recommodified while England did not.
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For groups with similar needs, the higher educated are more likely to seek healthcare. There were no trends in inequality in access to healthcare in Sweden.
Conclusion
This study has shown that recommodification is associated with health inequalities, especially in Sweden, and that inequalities in replacement rates are associated with health. However, the links between recommodification and health are context-dependent.