title: The recommodification of healthcare? A case study of user charges and inequalities in access to healthcare in Sweden 1980-2005.
abstract: BACKGROUND
  User charges in Swedish healthcare have increased during recent decades. This can be seen in terms of the recommodification of healthcare: making healthcare access more dependent on market position. This study investigates whether the increase in user charges had an impact on educational inequalities in access to healthcare in Sweden between 1980 and 2005.
  
  
  METHODS
  Data from the Swedish Living Conditions Survey were used to calculate the odds ratios of access to healthcare for the low and higher educated in Sweden, and the results were stratified by health status (Good and Not good health) for each year 1980-2005. These odds ratios were correlated with the average user charge for healthcare.
  
  
  RESULTS
  There were no educational differences in healthcare access in the group with Good health. In the group with Not good health, the higher educated had higher rates of healthcare access than the lower educated. Inequalities in access to healthcare were relatively stable over time, with a slight increase among those with Not good health.
  
  
  CONCLUSIONS
  Recommodification has had only a small association with access to healthcare in Sweden. The Swedish system has integral protections that protect the vulnerable against rising healthcare costs. This is an important caveat for other countries that are considering introducing or raising user charges.
authors.affiliation: Division for Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Wolfson Research Institute, Durham University, United Kingdom. Electronic address: kristin.farrants@ki.se.
authors.forename: Kristin
authors.initials: K
authors.lastname: Farrants
authors.affiliation: Institute for Health and Society, Faculty of Medical Sciences, Newcastle University, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: Bambra
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Sweden.
authors.forename: Lotta
authors.initials: L
authors.lastname: Nylen
authors.affiliation: Wolfson Research Institute, Durham University, United Kingdom.
authors.forename: Adetayo
authors.initials: A
authors.lastname: Kasim
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Burström
authors.affiliation: Centre for Public Policy and Health, Durham University, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hunter
mesh_terms: D003430:Cross-Sectional Studies; D004522:Educational Status; D005249:Fees and Charges / Q000706:statistics & numerical data* / Q000639:trends; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D019982:Organizational Case Studies; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: Access to healthcare; Health inequalities; Sweden; User charges