This dissertation explores the relationship between health-related payments and household economic well-being through the theoretical framework of decommodification. Particular attention is given to medicines, which are a majorcontributor to healthcare-induced financial hardship. The focus is on Finland duringthe period 2011–2020, a time characterised by welfare state restructuring and a pronounced emphasis on austerity.
The four sub-studies applied legislative microsimulation and Finnish administrative register data alongside multinomial and binary logistic regression, linear probability models, and both Finnish and European population survey datasets.
According to the microsimulation, health payment increases had negligible effects on relative poverty in 2011–2015. Between 2015 and 2019, health payment policies intensified the adverse effects of tax-benefit changes. Subjective experiences suggest that austerity coincided with a worsening relative position of chronically ill and people outside the labour market. Negative experiences with health payments were common, affecting people across all age and income groups. While payments were disproportionately borne by older adults, financial hardship was most concentrated among working-age individuals outside the labour market. Compared to Denmark, the Netherlands, Norway, and Sweden, the financial burdensfrom medicines and healthcare was more prevalent in Finland.
The results provide support for the understanding that recommodification undermines both the economic well-being of households and equal access to healthcare. Methodologically, the triangulation of subjective, objective and comparative perspectives provided new insights into the phenomenon. From a policy perspective, the results shed light on peoples’ experiences and attitudes during a timeof austerity and are envisaged to contribute to societal debates on the legitimacy andsharing of market risk between society and the individual.