Farrants Kristin, Bambra Clare
1 Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
2 Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, UK.
Scand J Public Health. 2018 Feb;46(1):18-26. doi: 10.1177/1403494817709191. Epub 2017 Jul 14.
This paper examines the effects of neoliberalism on health inequalities through an empirical examination of the recommodification of the social determinants of health. It uses a detailed case study of changes to three specific welfare policy domains in Sweden: unemployment, healthcare, and pensions.
Using time series data from the repeat cross-sectional Swedish Living Conditions Survey for 1980-2011, it examines: (1) the effects of reductions in the replacement rate value of unemployment benefit on inequalities in self-reported general health between the employed and the unemployed; (2) the effects of reductions in the replacement rate value of pensions on educational inequalities in self-reported general health among pensioners; and (3) the effects of the increase in user charges on inequalities in having visited a doctor in the past 3 months by educational level.
The results suggest mixed effects of welfare state recommodification on health inequalities: inequalities increased between the Swedish employed and unemployed, yet they did not increase in the retired population, and inequalities in access to healthcare also remained steady during the study period.
The paper concludes that the association between recommodification and health inequalities in Sweden is stronger regarding unemployment benefits than pensions or healthcare, and that this may relate to the stigmatisation of the unemployed.
本文通过对健康社会决定因素再商品化的实证研究，考察新自由主义对健康不平等的影响。它采用了瑞典三个特定福利政策领域变化的详细案例研究：失业、医疗保健和养老金。
利用1980 - 2011年瑞典生活条件重复横断面调查的时间序列数据，研究：（1）失业救济金替代率值的降低对就业者和失业者自我报告的总体健康不平等的影响；（2）养老金替代率值的降低对养老金领取者自我报告的总体健康方面教育不平等的影响；（3）用户收费增加对过去3个月按教育程度划分的就医不平等的影响。
结果表明福利国家再商品化对健康不平等的影响喜忧参半：瑞典就业者和失业者之间的不平等增加了，但退休人口中的不平等没有增加，而且在研究期间获得医疗保健的不平等也保持稳定。
本文得出结论，在瑞典，再商品化与健康不平等之间的关联在失业救济金方面比养老金或医疗保健方面更强，这可能与失业者的污名化有关。
