Disability Insurance Enrollment Research Articles

Does increasing health care access reduce disability insurance caseloads? Evidence from the rural United States.

This paper leverages the expansion of the United States' Community Health Center program over the 21st century to investigate whether improved access to health care reduces disability insurance (DI) participation at the county level. I find that the introduction of a health center that specializes in mental health and substance abuse services is associated with a 0.09 to 0.40 percentage point reduction in working-age DI enrollment in rural counties. A cost-benefit analysis indicates that the money saved from reduced program participation can account for more than a third of the cost the federal government faces in funding well-targeted health care access initiatives.

Job loss, disability insurance and health expenditure

We analyse the causal effect of job loss on disability insurance enrolment on a five-year horizon and the implications on health expenditure. Using administrative panel data from Hungary, we follow individuals displaced due to a mass lay-off and compare their labour force status to non-laid-off individuals with similar employment and health history. According to our estimates, being laid off increases the transition probability to disability 1.5-fold (or by 1.4% points) in four years, and half of the excess transitions occur within the first year. The four-year mortality rate increases 1.7-fold (or by 0.4% point).Total outpatient, inpatient and pharmaceutical expenditure increase threefold when a laid-off individual takes up disability benefit, and decrease slightly afterwards, but do not reach the pre-disability levels. The medium term increase in health expenditure corresponds to 20−25% of the additional disability payments. Detailed medication data show that physical health shocks, the diagnosis of chronic physical conditions, such as hypertension or diabetes, and the deterioration of mental health all contribute to the observed surge in health expenditure.

Locate Your Nearest Exit: Mass Layoffs and Local Labor Market Response

Large shocks to local labor markets can cause long-lasting changes to employment, unemployment, and the local labor force. This study examines the relationship between mass layoffs and the long-run size of the local labor force. The authors consider four main channels through which the local labor force may adjust: in-migration, out-migration, retirement, and disability insurance enrollment. These channels, primarily out-migration, account for more than half of the labor force reduction over the past two decades. Findings show, however, that during and after the Great Recession, instead of out-migration, non-participation in the labor force grew to account for most of the local labor force exits following a mass layoff.

Social Security Disability Insurance Enrollment and Health Care Employment.

To examine the relationship between Social Security Disability Insurance (SSDI) enrollment and health care employment. State-year level data from government and other publicly available sources for all states (2000-2014). Population-weighted linear regression analyses model associations between each health care employment measure and each SSDI enrollment measure (i.e., SSDI overall, physical, or mental health enrollment rates), controlling for factors associated with health care employment, state fixed effects, and secular time trends. Data are gathered from publicly available sources. A one standard deviation increase in SSDI enrollment per 100,000 population is associated with a statistically significant 2.6 and 4.5 percent increase in the mean employment rate per 100,000 population for health care practitioner and technical occupations and health care support occupations, respectively. The size of this relationship varies by the type of disabling condition for SSDI enrollment (physical versus mental health). Social Security Disability Insurance enrollment is significantly associated with health care employment at the state level. Quantifying the magnitude of this relationship is important given high SSDI enrollment rates as well as evolving policy and demographic shifts related to the SSDI program.

The Decentralization of Social Assistance and the Rise of Disability Insurance Enrolment

Fiscal decentralization, the decentralization of government expenditures to local governments, may enhance public sector efficiency. Vertical externalities, i.e. spillovers between local and central government, could however undo part of this advantage. In this paper we estimate spillovers from Social Assistance (SA), administered by municipalities, towards central government’s Social Security Disability Insurance (SSDI) scheme in The Netherlands. The latter scheme saw rapidly rising enrolment rates after financial responsibility for Social Assistance was transferred from central to local government. We find that the correlation between local SSDI enrolment and the local stock of SA benefits recipients has increased significantly in the years after decentralization. We show that an increased caseload shifting from Social Assistance to Disability Insurance is the only plausible explanation for this change. Our analysis shows that, following the decentralization of Social Assistance, at least one third of the SSDI inflow was diverted from SA. This caseload shifting increased more rapidly in municipalities experiencing deficits on their SA budgets than in municipalities running a surplus.

Does Disability Insurance Improve Health and Well-Being?

The purpose of disability insurance (DI) is to protect people with health problems that limit their ability to work. We evaluate the effectiveness of DI benefit programs in delivering this protection by following people’s health and financial well-being after the take-up of DI benefits. This paper takes advantage of internationally harmonized panel data and the differences across DI programs in Europe and the United States, as well as their changes over time. We use several econometric approaches to account for the potential endogeneity of DI enrollment and sample selectivity. We find that self-reported health stabilizes after DI benefit receipt. Mental health improves more for DI benefit recipients than non-recipients relative to the beginning of DI benefit receipt. This effect is stronger in countries with more generous DI systems. The effects on objective health measures are positive but largely insignificant.

Locate Your Nearest Exit: Mass Layoffs and Local Labor Market Response

Large shocks to local labor markets cause lasting changes to communities and their residents. We examine four main channels through which the local labor force adjusts following mass layoffs: in- and out-migration, retirement, and disability insurance enrollment. We show that these channels account for over half of the labor force reductions following a mass layoff event. By measuring the residual difference between these channels and labor force change, we also show that labor force non-participation grew in the period during and after the Great Recession. This result highlights the growing importance of non-participation as a response to labor demand shocks.

Employers Opting Out of Public Disability Insurance: Selection or Incentive Effects?

This paper analyzes selection and incentive effects of opting out from public to private insurance on employer Disability Insurance (DI) inflow rates. We use administrative information on DI benefit costs and opting-out decisions of a balanced panel of about 140,000 employers that are observed between 2007 and 2011. We argue that the opting-out decision of employers was driven by current DI enrolment and anticipation effects that resulted from short-term expectations on DI costs. In particular, employers opted out when this was most rewarding for them in reducing DI premium rates. When controlling for these effects, our main finding is that there are no incentive effects due to opting out. Thus, publicly and privately insured employers show similar DI inflow rates.

The Rise and Fall of Disability Insurance Enrollment in the Netherlands.

As recently as 15 years ago, the high level of Disability Insurance (DI) enrollment was considered to be one of the major social and economic problems of the Netherlands; indeed, the Netherlands was characterized as the country with the most out-of-control disability program of OECD countries. But since about 2002, the Netherlands has seen a spectacular decline in its Disability Insurance enrollment rate. Radical reforms to the Dutch DI system were implemented over the period 1996 to 2006. We cluster these reforms in three broad categories: 1) reducing the incentives of employers to move workers to disability; 2) increased gatekeeping; and 3) tightening disability eligibility criteria while enhancing worker incentives. The reforms appear to have been very effective. Since 2002, yearly DI inflow rates dropped from 1.5 percent in 2001 to about 0.5 percent of the insured population in 2012. We argue that particularly the interaction of employer incentives and formal employer obligations has contributed to the substantial decrease in DI inflow. On the downside, however, it seems workers with bad health have sorted into temporary employment—without employers bearing the financial responsibility of their benefit costs.

Employers Opting Out of Public Disability Insurance: Selection or Incentive Effects?

This paper analyzes selection and incentive effects of opting out from public to private insurance on employer Disability Insurance (DI) inflow rates. We use administrative information on DI benefit costs and opting-out decisions of a balanced panel of about 140,000 employers that are observed between 2007 and 2011. We argue that the opting-out decision of employers was driven by current DI enrolment and anticipation effects that resulted from short-term expectations on DI costs. In particular, employers opted out when this was most rewarding for them in reducing DI premium rates. When controlling for these effects, our main finding is that there are no incentive effects due to opting out. Thus, publicly and privately insured employers show similar DI inflow rates.

A life-cycle model of unemployment and disability insurance

A general equilibrium life-cycle model is developed, in which individuals choose a sequence of saving and labor supply faced with search frictions and uncertainty in longevity, health status and medical expenditures. Unemployed individuals decide whether to apply for disability insurance (DI) benefits if eligible. We investigate the effects of cash transfer and in-kind Medicare component of the DI system on the life-cycle employment. Without Medicare benefits, DI coverage could fall significantly. We also study how DI interacts with reforms of Social Security and Medicare and find that DI enrollment amplifies the effects of reforms.

Health, disability and work: patterns for the working age population

We examine the role of health as a determinant of labour force participation, paying particular attention to the link between the two provided by disability insurance schemes. We first review the evidence on associations between health and labour force participation. Enrolment in disability insurance is not determined by health alone, and we highlight the main other causes that the literature has identified. In an application to The Netherlands, we follow the structure of the literature review and show that the trends in health and disability insurance enrolment look rather positive. In particular, the 1990 reforms of disability insurance might have been more effective than previously realised because part of their success was hidden by demographic change: The large number of baby boomers kept the absolute inflow high as they aged, despite large reductions in relative rates.

Disability insurance and unemployment insurance as substitute pathways

In this article, we estimate the degree of substitution between enrolment into Disability Insurance (DI) and Unemployment Insurance (UI) in the Netherlands. Starting in the 1990s many policy measures aimed at reducing DI enrolment, and increase labour force participation. We quantify whether these policy measures have led to a reduction in hidden unemployment in DI. A side effect of the reforms may be increased pressure on UI. Therefore, we simultaneously estimate reverse substitution, that is, hidden disability in UI. To this end, we employ a sample of firms in the Dutch AVO database from the period 1993 to 2002. Using instrumental variables in a bivariate Tobit specification, we identify the hidden components in both respective schemes. The estimation results indicate that about 3% of all dismissals took place through DI, which implies that about one quarter of the DI enrolments observed in our sample in fact consists of hidden unemployment. We find no evidence for reverse substitution of disabled persons ending up in UI.

Work Disability, Health, and Incentive Effects

Disability insurance – the insurance against the loss of the ability to work – is a substantial part of social security expenditures in many countries. The enrolment rates in disability insurance vary strik-ingly across European countries and the US. This paper investigates the extent of, and the causes for, this variation, using data from SHARE, ELSA and HRS. We show that even after controlling for differences in the demographic structure and health status these differences remain. In turn, indicators of disability insurance generosity explain 75% of the cross-national variation. We conclude that country-specific disability insurance rules are a prime can-didate to explain the observed cross-country variation in disability insurance enrolment.

Financial Incentives in Disability Insurance in the Netherlands

In this article, we assess the impact of financial incentives on the inflow in the public Disability Insurance (DI) scheme in The Netherlands. For this matter, the variation in replacement rates over different sectors is exploited to estimate the probability of DI enrolment over a sample of employees from the Dutch Income Panel (1996–2000). On the basis of these administrative data, we find a point estimate of the elasticity of DI enrolment with respect to the DI wealth rate of 2.5. Simulations indicate that a 5%-point rise in replacement rates in the two first years of DI increases DI enrolment by 6%.