Disability Support Pension Research Articles

Effects of socioeconomic disadvantage on renal failure hospital admissions in Victoria.

5 years of age. RFAs had the sixth highest 30-day readmission (15%). One-tenth of the patients died in hospital. The RFA rates varied inversely with SED (r=–0.51, P <0.01).Thecoefficientofvariationwas0.44and0.16forRFA andalladmissions,respectively,indicatingthatRFAshadgreater variability by LGA than all admissions. The mean RFA rate for the top percentile LGAs was 2.4-fold greater than that of the bottom percentile LGA (13.21 (95% CI 11.44–14.93) vs 5.62 (95% CI 4.43–6.95), respectively). The top percentile group was the most disadvantaged, including Central Goldfields, Loddon and Mildura. The bottom percentile group include Bayside, Boroondara and Nillumbik. LGAs with high RFA rates also had high hospital admission ratesforotherconditions,suchasheartfailure(r=0.58,P <0.01) and chronic obstructive pulmonary disease (r=0.49, P <0.01), and prevalence of hypertension (r=0.32, P <0.01) and obesity (r=0.26,P <0.05). Residents of disadvantaged communities are significantly more likely (r=0.45, P <0.01) to be on a Disability Support Pension (Table 1). Inconclusion,thevariationsinRFAratesmayreflectmultiple factors, particularly access to adequate care, delayed referral to Table 1. Inter-correlation coefficients for age-standardised renal failure hospitalisation rates and key variables *P <0.05, **P <0.01 (two-tailed). SED, socioeconomic disadvantage; REN, age-adjusted renal failure admissions per 10 000 population; HRF, age-adjusted heartfailureadmissionsper10 000population;COP,age-adjustedchronicobstructivepulmonarydiseaseadmissionsper10 000population;OCA,proportionof thepopulationundertakingmostlyheavylabourorphysicallydemandingactivity;HYP,prevalence(%)ofhypertension;OBE,prevalence(%)ofoverweightand obesity;HLS,prevalence(%)offairorpoorself-reportedhealthstatus;CAN,prevalence(%)ofcancer;DSP,proportionofthepopulationonDisabilitySupport

Musculoskeletal malignant neoplasms hospitalisation in Victoria

The paper describes factors associated with 2,605 hospital admissions for musculoskeletal malignant neoplasms (MMN) over oneyear. The rates per 10,000 population increased significantly (t=5.3, p&lt;.01) with age, with men (4.5 per 10,000 population, 95% CI 4.1-5.0) at greater risk than women (3.3 per 10,000 population, 95% CI 2.8-3.7). The 30-day readmission rate was 19%, thethird highest of all admission categories. The average length of stay was significantly (t=4.5, p&lt;.01) shorter in the metropolitanarea (8.2 days) than in rural communities (10.8 days). The age-standardised rates varied inversely (r=-0.28) with socioeconomicstatus. Communities with high MMN admission rates had high rates of heart failure admissions (r=0.35), alcohol consumption(r=0.34) and receiving Disability Support Pension (r=0.32). There was a significant (t=13.8, p&lt;.001) monthly variability inMMN hospitalisation rates. As a leading cause of hospital readmission and disability, the condition requires closer analysis.

The Impact of Age Pension Eligibility Age on Retirement and Program Dependence: Evidence from an Australian Experiment

Abstract Governments around the world are reforming their social security systems in light of the challenges posed by population aging. We study the 1993 Australian Age Pension reform, which progressively increased the eligibility age for women from 60 to 65 years. We find economically significant responses to the reform. An increase in the eligibility age of one year induced a decline in the probability of retirement by 12 to 19 percentage points. In addition, the reform induced significant program substitution, with increases in enrollment in other social insurance programs, particularly the disability support pension, which effectively functioned as an alternative source of retirement income.

Prevalence and Correlates of Sleep Disturbance in Postmenopausal Women: The Australian Healthy Aging of Women (HOW) Study

Sleep disturbance in midlife women has been studied extensively, although less is known about sleep after menopause. This study examined the relative impact of sociodemographics, modifiable lifestyle factors, and health status on sleep disturbance in postmenopausal women from Queensland, Australia. The longitudinal Healthy Aging of Women (HOW) Study examines health-related quality of life (HRQOL measured by the 12-item Short Form [SF-12(®)] survey [Medical Outcomes Trust, Hanover, CA]); chronic illness; modifiable lifestyle factors, such as physical activity, alcohol consumption, smoking; and sleep disturbance (General Sleep Disturbance Scale [GSDS] (Lee, San Francisco, CA) ≥43 represents poor sleep) in midlife and older women from low- and high-socioeconomic rural and urban areas of South East Queensland, Australia. This article presents cross-sectional data from the 322 women, aged 60-70 years, participating in the HOW study in 2011. For women in this study, sleep disturbance was relatively common, with 23% (n=83) reporting poor sleeping (GSDS ≥43). Sleep-disturbance scores were strongly correlated with being unemployed or on a disability support pension (β=18.69, p<0.01), sedentary lifestyle (β=23.84, p<0.01), and lower mental (β=-0.60, p<0.01) and physical HRQOL scores (β=-0.32, p=0.01), and these variables explained almost one-third of variance in sleep-disturbance scores (ηρ(2)=29%). Multivariable analysis revealed that sleep disturbance was correlated with physical and mental HRQOL, disability, and sedentary lifestyle but not other lifestyle and sociodemographic characteristics. It may be, however, that modifiable lifestyle factors may indirectly impact sleep by influencing health status.

Explaining the Growth in the Number of Recipients of the Disability Support Pension in Australia

This article shows that one-third of the growth in the Disability Support Pension (DSP) recipiency rate over the last 30 years can be explained by population ageing and increases in the retirement age for women. A wide range of factors is likely to have contributed to the remaining growth, but we argue that the growing attractiveness of DSP compared to other income-support payments has played an important role. Looking forward, population growth and planned increases in the retirement age will both put upward pressure on the DSP roll, which, without major reform, could plausibly hit 1 million recipients within 10 years.

Is Australia One Recession Away from a Disability Blowout? Lessons from Other Organisation for Economic Co-operation and Development Countries

A blowout in disability-based cash transfer programmes resulted in fundamental reforms over the last decade in several Organisation for Economic Co-operation and Development countries. Similar reforms are being proposed in the United States in the wake of its disability programme growth following the Global Financial Crisis. We compare trends in US and Australian disability receipt with those of the Netherlands and Sweden and argue that Australia's current Disability Support Pension programme is vulnerable to the same forces that caused unsustainable programme growth in these countries. Absent fundamental reforms focused on return to work over benefit receipt means that Australia could be one recession away from disability benefit blowout.

Do Residual Benefits Induce Disability Support Pension Leavers to Return to Income Support?

This study looks at whether the residual benefits retained by former Disability Support Pension (DSP) recipients induce them to return to income support before the benefits expire. DSP recipients who leave the payment to work retain access to pensioner concession cards, including bulk-billing for doctors’ appointments and concessionary treatment for other health services, along with pharmaceutical benefits and access to valuable state government concessions for 12 months after leaving the DSP. They also enjoy an administratively ‘smoother’ return to the payment, if required, since their payment is only suspended rather than cancelled, for up to 24 months after leaving the DSP. This paper looks at whether former DSP recipients tend to return to the DSP just prior to the expiry of these benefits. It uses government administrative data on income support receipt, the Longitudinal Data Set (LDS), to assess whether there are any spikes in the rate of return to income support among DSP leavers just before the one and two-year anniversaries of their leaving the DSP. There are really two issues to consider in analysing this issue: whether any observed spike in returns is statistically significant and whether any observed spike is economically significant. Such a spike may be the former but not the latter. The economic significance of any such behaviour appears to be quite small. Administrative data suggest that about two-thirds of those who return to the DSP have done so within six months of leaving it, as do about half of those who return to another income support payment. If most people who return to income support do so well before the critical anniversaries of leaving the DSP, it seems unlikely that these thresholds can be economically important in inducing people to return to the DSP. There is no evidence of a statistically significant spike either. An analysis of the time people spend off benefits before returning to income support does not point to any spikes in the return rates just prior to the 12 or 24-month mark. Consequently, it seems unlikely that the existence of the residual benefits retained after DSP recipients leave the payment has a significant impact on whether people return to income support. Rather, real factors like the state of the labour market and the attachment of individuals to work, as evidenced by whether they were employed when initially on the DSP, are more influential in determining whether those who leave the DSP can remain off it. Other factors that influence whether those who leave the DSP remain off this or other forms of income support are noted below: •Individuals aged 55 to 64 when they originally commenced on the DSP were more likely to have returned to income support by June 2007, but to the age pension rather than the DSP. •Individuals aged 35 to 44 years when they originally commenced on the DSP originally were no more likely to have returned to welfare than younger workers, but those who did returned to the DSP rather than other payments. •Females, married people and those with non-labour income were more likely to return to income support other than the DSP. •Those living in remote areas were more likely to return to the DSP.

Financial Hardship and Emergency Relief in Victoria

The existence and provision of emergency relief remains one of the more contentious aspects of poverty relief in Australia. This is largely due to a fundamental difference of opinion within government and the welfare sector about how to best tackle the financial hardship being experienced by people in need. Some contend that emergency relief should be expanded and better funded by the Commonwealth, whereas others believe it should be discontinued altogether and replaced by more generous social welfare payments. This debate continues unresolved for a number of reasons, including a lack of reliable and comprehensive data on who uses emergency relief in Australia and why. This paper reports on a State-wide investigation undertaken of emergency relief use in Victoria between 2007 and 2008. It has found that existing social welfare recipients—especially those on the disability support pension, parenting payment, and Newstart allowance—are the main users of emergency relief, who are living in households headed by a single adult, and forced to rent housing in the private sector. A disaggregation of the findings over both time and spatial regions of Victoria suggests that the level of need is not uniform. Several recommendations are offered to address the financial hardship that some people living in differing parts of Victoria face on an ongoing basis.

Dracula in Charge of the Blood Bank

AbstractThe Harmer–Henry pension and tax review resulted in an increase in the common value of the single rate of Age Pension and Disability Support Pension from 25 per cent to 28 per cent of male total average weekly earnings. It also recommended a Resource Super Profits Tax that would have initially taxed mining ‘rents' at 36 per cent, on top of the pre-existing 30 per cent federal tax on profits. These recommendations represent two sides of the same coin: higher federal spending alongside higher federal taxes. The pension rise is likely to reduce participation in the labour force. The proposed tax rise would discourage mining activity as miners considered their options to delay or abandon projects. There is a lot to like at the level of detail in the Harmer–Henry package, but future efforts to reform our tax-transfer system should focus on promoting saving and investment, including investment in human capital.

The changing profile of mental disorders among Disability Support Pension recipients

The changing profile of mental disorders among Disability Support Pension recipients

Severity of Work Disability and Work*

A dynamic labour force participation model is used to capture the effect of severity of disability on labour force participation using a sample of working age Australians drawn from the Household, Income and Labour Dynamics in Australia survey. The role of work limitation is shown to be significantly dissimilar across gender, age and severity groups. The simulated impact of limitations is most dramatic for low-skilled women. The new work requirements imposed on Disability Support Pension recipients are shown to be highly effective for this group.

The Influence of Baseline Characteristics on Response to a Laser Acupuncture Intervention: An Exploratory Analysis

In clinical practice it is known that subjects vary in their response to acupuncture, but there is little data on what predicts the outcome. The aim of this study was to identify such predictors. A secondary analysis was performed on data from 100 participants in a trial of laser and sham laser acupuncture for chronic non-specific low back pain. Multiple regression analysis was used to identify which baseline characteristics predicted pain change in the immediate, short and intermediate term. An analysis of covariance was performed based on these results to re-examine the primary result of the trial. Strong predictors of poor response were receipt of disability support pension, headache, the regular use of analgesics or previous failed back surgery. Higher pain scores or exacerbation of pain at baseline predicted a greater proportionate pain relief after the intervention. Adjusted analysis suggested a clinically important effect of laser compared to sham (p<0.05), at short term follow-up only. The findings of this study suggest which characteristics of patients with chronic low back pain are more likely to respond to laser acupuncture treatment, but require replication in other studies. The findings may not apply in other acupuncture interventions and treatment of different conditions. They may also be used to set selection criteria for future studies, and to aid interpreting the effect of baseline imbalances on trial results.

Readmission to an acute psychiatric unit within 28 days of discharge: identifying those at risk

To examine factors that could help identify those most at risk of readmission to an acute psychiatric in-patient unit within 28 days of a discharge. A detailed file audit was conducted comparing 54 consecutive patients who had been readmitted within 28 days of discharge with 61 patients, chosen at random, who had not been readmitted during the same period. Readmission within 28-days of discharge was associated with having been admitted in the previous year (P = 0.004), receiving the Disability Support Pension (P = 0.015), not having a discharge plan sent to the patient's GP on discharge from the index admission (P = 0.05), receiving follow-up by the mental health team within 7 days of discharge (P = 0.007) and being unemployed (P = 0.015). Targeting those with previous admissions for focussed discharge planning may help organisations reduce the numbers of unnecessary early readmissions.

Who to Serve? The Ethical Dilemma of Employment Consultants in Nonprofit Disability Employment Network Organisations

The Welfare‐to‐work policy, implemented in July 2006 by the Federal Government, imposed a new work and activity obligation on people applying for the Disability Support Pension. This requirement not only created a new obligation for people with disability but also for employment consultants working in nonprofit Disability Employment Network organisations to monitor the conduct of this new cohort on behalf of Centrelink. For many employment consultants traditionally drawn to the nonprofit disability sector for altruistic reasons, this has created an ethical dilemma between their duty to their employer, and acting in the best interests of their clients. Drawing on aspects of ethical theory we find that, although most employment consultants justify their actions in terms of duty to the organisation, some find themselves in an ethical dilemma of ‘who to serve’ when the interests of the organisation and the welfare of the client are mismatched.

Severity of Work Disability and Work

This paper analyzes the effect of severity of disability on labour force participation by using a self-reported work limitation scale. A dynamic labour force participation model is used to capture the feedback effect of past participation on current participation. The results suggest that net of persistence and unobserved heterogeneity, differences in severity levels explain a significant portion of the variance in the participation rates among disabled individuals. Moreover, the disability is shown to have longer lasting adverse effects on female participation and work limited women will be more likely to benefit from the work requirements imposed on Disability Support Pension recipients.

Men Not at Work: An Analysis of Men Outside the Labour Force

The Productivity Commission Staff Working Paper, 'Men not at Work: An Analysis of Men Outside the Workforce' (by Ralph Lattimore), was released in January 2007. This paper analyses the characteristics of adult men outside the labour force in Australia. The paper finds that, in contrast to women, the rates at which men are disengaged from the labour force have increased fourfold over the past century, rising especially rapidly over the last 50 years. There are many drivers of this transformation of the Australian labour market. Some of it is due to: population ageing; younger men are spending longer in education; older men are enjoying a longer voluntary retirement; and men are now much more involved in domestic and childcare tasks - 30 per cent of those aged 35 to 44 years are not in the labour force for this reason. Many prime-aged males leave the labour market due to injury, ill-health, disability or premature 'retirement'. About half the men aged 25 to 64 years who are outside the labour force receive the Disability Support Pension. Inactive men are more likely to be living alone, be poorly educated, and of indigenous or non-English speaking migrant background. A man aged 45 to 54 years living alone is about four times more likely to be outside the labour force than one who is married or who has a partner. The paper does not make any recommendations, but the research should assist policy development in areas central to getting more men into or back into the workforce. The views expressed in this paper are those of the staff involved and do not necessarily reflect those of the Productivity Commission.

Welfare to Work in Australia: Disability Income Support, Housing Affordability and Employment Incentives

Internationally, considerable policy attention is being paid to increasing the employment participation of disabled working-age people. Like other OECD countries, Australia has experienced growth in the number of Disability Support Pension (DSP) recipients due to changes in industry structure and increases in precarious employment. This history is well-rehearsed in policy debates. However, little research attention has been given to the housing circumstances of DSP recipients. This is important, particularly when we note the increasing incidence of working-age DSP recipients in the private rental market and public housing. For public renters the incidence has more than tripled to 27 per cent over the period 1982-2002. This paper addresses two questions: 'What are the housing circumstances of DSP recipients?' and 'What are the likely consequences of programme changes aimed at increasing employment participation of DSP recipients?' Using Australia as an example, this article considers interactions between the new disability payment system being implemented through Welfare to Work, housing costs and employment income.

Influence of rheumatoid arthritis on work participation in Australia

The aim of the study was to determine the prevalence of work disability in a cohort of Australians with rheumatoid arthritis. A cross-sectional study of a sample of 497 individuals aged 18-65 years with rheumatoid arthritis in Adelaide, South Australia, was carried out. Of those employed, 130 (51%) were in full-time employment (> or= 35 h per week) work and 124 (49%) were in part-time employment (average 20 h per week). Overall, the observed/expected numbers working were 254/316 (relative risk 0.8 (0.69-0.91)). Using a comparator adjusted by removing those on the disability support pension, the relative risk of the working was 0.74. The observed/expected numbers working part time in the study group were 124/89 (relative risk 1.4 (1.25-1.65)). Those who continued to work had lower Health Assessment Questionnaire scores, less morning stiffness, superior scores for patient assessed level of function, lower pain scores, lower joint counts, a lower C-reactive protein, better measures of 'patient global assessment' and higher levels of education compared with the group who had ceased work. Overall, of those working at the time of diagnosis, 20% had ceased work within 5 years and approximately 40% had ceased work by 20 years. Of those who ceased work, the mean duration from time of diagnosis to work cessation was 7 years with half the subjects who ceased work doing so within 4 years of diagnosis. Work disability associated with rheumatoid arthritis in Australia is very significant and costly. Work disability occurs relatively early in the disease and is associated with several identifiable variables, many of which may be amenable to intervention strategies.

Models of Disability, Work and Welfare in Australia

Abstract In discourse around disability there has been a shift away from a ‘medical model’, which perceives disability as an individual problem to be ‘cured’ or contained, towards a ‘social model’. The latter focuses on the relationship between people with disabilities and their social environment, locating the required interventions within the realm of social policy and institutional practice. Drawing upon a small qualitative study conducted in Melbourne, this article argues that recent plans by the Australian government to introduce mutual obligation requirements for recipients of the Disability Support Pension (DSP) sit in tension with this shift from the medical to the social models of disability. Mutual obligation is based on the assumption that income support recipients need to be taught how to be more ‘self‐reliant’, to ‘participate’ in society more fully and to become ‘active’, rather than ‘passive’, citizens. This language appears to overlap with that used to articulate a social model, which places emphasis on participation in the community and attempts a shift away from reliance on the medical profession. However, examples from interviews conducted with current and former DSP recipients demonstrate that, in practice, mutual obligation is likely to reinforce a medical model of disability, frame DSP recipients as ‘conditional’ citizens and ignore the obligations of the state and society regarding access and inclusiveness for people with disabilities.

Disability Support Pension Recipients: Who Gets Off (and Stays Off) Payments?

AbstractWe use Centrelink payment records on Disability Support Pension (DSP) recipients over the period 1995 to 2002 to investigate individual transitions off payments. Our findings are consistent with the existence of a close correspondence between disability benefit receipt and labour market outcomes: entry to DSP via unemployment benefits is associated with substantially reduced prospects of exiting DSP, while employment during the DSP spell is associated with not only an increased probability of exiting DSP, but also more success in staying off payments once an exit has been made. A further finding of our analysis is that persons who exit DSP due to take‐up of employment have a relatively high rate of return to payments compared with persons who exit for other reasons, and indeed exhibit a high propensity to cycle off and on payments.