Disability Benefit Recipients Research Articles

The implosion of the Dutch surveillance welfare state

AbstractFrom the 1990s onwards, fraud detection has become an increasingly important focus in the design and implementation of a variety of welfare schemes, including unemployment benefits, social assistance benefits, pensions, and personal care budgets. This culminated in the 2014 Fraud Act, which introduced a system of high sanction in all cases of benefit fraud, even if they were causes by administrative errors. In 2020 a parliamentary investigation committee concluded that the Dutch government had violated the foundational principles of the rule of law through the way suspected fraudsters with childcare allowances had been treated. This so‐called Childcare allowances affair undermined the support for the harsh approach to fraud and led to a series of proposals to reform the Dutch ‘surveillance welfare state’. The Dutch Childcare allowances affair is an interesting case of a social policy crisis because its origins are not external events but lie in the regular implementation of policies that have been approved and supported rather widely by politicians, policymakers and street‐level bureaucrats. In this article, we define and apply the concept ‘institutional implosion’ to analyse the Childcare allowances affair and its consequences. Moreover, we argue that the implosion in this affair follows from an extension of the target group from ‘non‐deserving’ to ‘deserving’ citizens. Whereas the Fraud Act primarily was aimed towards recipients of unemployment, disability and social assistance benefits, a change in the system of childcare allowances extended the scope of the Fraud Act to an almost universal group of parents that use childcare facilities.

Process evaluation of a comprehensive approach to reintegration of disability benefit recipients with multiple problems (CARm) into the labour market

Purpose As the effect evaluation of our randomized controlled trial the “Comprehensive Approach of Reintegration for clients with Multiple problems” (CARm) showed no superior effect on re-integration into paid employment of the clients when compared with clients of the care as usual, we conducted this process evaluation to gain insight into whether the intervention was conducted according to protocol. Methods Using questionnaires on recruitment, reach, dose delivered, dose received, fidelity, context, and satisfaction we collected data from 40 labour experts of the Public Employment Service of the Dutch Social Security Institute, and from 166 disability benefit recipients dealing with multiple problems. Results Only few of the labour experts provided the key elements of the intervention to their clients. Between the clients of both groups were no significant differences in the dose received. More than half of the labour experts of the intervention group reported organizational changes. Conclusion The lack of effect of the CARm intervention was almost certainly caused by implementation failure. Once again this study showed the importance of involving all stakeholders in developing and the conduct of the intervention, and of clarifying the consequences for the organization, to ensure that it can be conducted according to protocol.

The Impact of Work Incentives Benefits Counseling on Employment Outcomes: A National Vocational Rehabilitation Study.

Millions of Americans receiving Social Security Administration (SSA) disability benefits aspire to work and reduce reliance on disability benefits, but find the rules about entering or rejoining the workforce too complex or confusing and fear that working will cause loss of important benefits. A case control study was conducted to investigate the impact of receiving work incentives benefits counseling (WIBC) on employment outcomes, and its relationship with demographic covariates for U.S. vocational rehabilitation (VR) clients who are SSA disability benefit recipients. Data for this study were extracted from the Rehabilitation Service Administration (RSA-911) database. Mahalanobis distance matching procedures were used to match clients who received WIBC with those who did not receive it. Chi-square independence tests and independent samples t tests were used to compare receipt of WIBC and employment outcomes based on the demographic variables. Additionally,chi squared automatic interaction detection (CHAID) analysis was used to divide VR clients into homogeneous groups based on the covariates. Clients who received WIBC were more likely to obtain competitive integrated employment (CIE). Impairment type, referral source, long-term employment and education level were significantly associated with CIE for clients who received WIBC. Additionally, VR clients with sensory/communicative impairments and low-income status were less likely to receive WIBC. Modifying VR structure to be more inclusive; understanding of stigma; and increasing the functioning, psychological well-being and self-efficacy of VR clients might improve employment outcomes.

“In Every Decision I’m Making, I’m Thinking About My Son”: How Children Motivate and Constrain the Labor Force Participation of Mothers With Disabilities

Although women’s employment patterns are influenced by both the presence of children and the presence of a disability, these distinct statuses have largely been explored in isolation from each other. This research employed in-depth interviews with 32 current and former disability benefit recipients to explore the ways children shape the labor market decisions and behaviors of mothers with disabilities. Motherhood served as both a motivation for and a constraint to pursuing employment, with mothers operating under distinct cost–benefit frameworks shaped by their responsibility for children. The report concludes with recommendations for programs and policies that could most effectively facilitate labor market reengagement among a subpopulation of mothers who both want to and need to work but who face unique child-related constraints to employment opportunities.

Comprehensive approach to reintegration of disability benefit recipients with multiple problems (CARm) into the labour market: results of a randomized controlled trial

Purpose Although most clients on work disability benefits face multiple problems, most traditional interventions for (re)integration focus on a single problem. The aim of this study was to evaluate the “Comprehensive Approach to Reintegrate clients with multiple problems” (CARm), which provides a strategy for labour experts to build a relationship with each client in order to support clients in their needs and mobilize their social networks. Methods This study is a stratified, two-armed, non-blinded randomized controlled trial (RCT), with a 12-month follow-up period. Outcome measures were: having paid work, level of functioning, general health, quality of life, and social support. Results We included a total of 207 clients in our study; 97 in the intervention group and 110 in the care as usual (CAU) group. The clients’ mean age was 35.4 years (SD 12.8), 53.1% were female, and 179 (86.5%) reported multiple problems. We found the CARm intervention to have no significant effects superior to those of the CAU group on all outcomes. Conclusion As we found no superior effect of the CARm intervention compared to CAU, we cannot recommend widespread adoption of CARm. A process evaluation will give more insight into possible implementation failure of the intervention. IMPLICATIONS FOR REHABILITATION Most traditional interventions for (re)integration into the labour market are problem-centred, i.e., focusing on a single problem, and have limited effectiveness in persons with multiple problems. A strength-based intervention may be suitable for vocational rehabilitation and disability settings, since it contains many elements (e.g., being strength-based, focused on clients’ wishes and goals, and involving activation of the social environment) also likely to improve chances of re-employment of persons with multiple problems. In this study a strength-based intervention did not show a superior effect on paid employment and functioning within one year follow-up compared to care as usual in people with multiple problems on a work disability benefit.

Effects of rehabilitative psychotherapy on labour market success: Evaluation of a nationwide programme.

Psychotherapy is a widely used treatment for mental disorders, but whether it also improves employment and other labour market outcomes remains inconclusive. This study examined the effectiveness of a nationwide subsidized psychotherapy programme using extensive register-based data. The sample consisted of individuals who applied for rehabilitative psychotherapy in Finland in 2009-2012 (n = 35,083). Prior to 2011, some applications were rejected due to the limited budget that the central government provided for the programme. From 2011, all eligible applicants were granted rehabilitation. We used propensity score matching to create balanced samples of those who received a negative decision in 2009-2010 (n = 2047) and those who were granted rehabilitative psychotherapy in 2011-2012 (n = 12,046) in terms of their sociodemographic background characteristics, prior labour market attachment and health status. We found that compared to the applicants who were not accepted to the programme, the granted applicants with similar background characteristics had, on average, a six-percentage-point higher employment rate, €2100 higher annual earnings and a six-percentage-point lower probability of becoming a disability benefit recipient five years after their first application. Further sensitivity analyses confirmed that these results were not biased, for example, by differences in macroeconomic conditions during the follow-up. Quasi-experimental research design showed that rehabilitative psychotherapy was significantly associated with better labour market outcomes. Although several relevant background factors were included in the matching analysis, it is possible that some unobserved factors explain both access to psychotherapy and subsequent labour market outcomes.

Prevalence, types, and combinations of multiple problems among recipients of work disability benefits

Purpose For persons on disability benefits who are facing multiple problems, active labour market policies seem less successful. Besides health problems, these people perceive personal, social, and environmental problems. Since very little is known about these “non-medical” problems our aim was to explore the prevalence of clients experiencing multiple problems, the types and number of perceived problems, combinations of perceived problems, and associated characteristics in a group of work disability benefit recipients. Methods We performed a cross-sectional study, using self-reported data on perceived problems and socio-demographics, and register data from the Dutch Social Security Institute on diagnosed diseases and employment status. A convenient group of labour experts recruited eligible clients on work disability benefit. Results Of the 207 persons on work disability benefit, 87% perceived having multiple problems. Most reported problems were related to physical (76%) or mental (76%) health. Health problems most frequently occurred together with a mismatch in education, financial problems, or care for family members. Clients with lower education experienced significantly more problems than clients with an intermediate or high educational level. Conclusions Clients with multiple problems face severe and intertwined problems in different domains of life, and need tailored multi-actor work disability management. Implications for rehabilitation Clients with multiple problems face severe and intertwined problems in different domains of life; therefore, interventions tailored to deal with needs related to specific problems might be more effective than traditional programs. Interventions should match experienced barriers, and involve multi-actor work disability management with all the challenges of mutual cooperation. For persons with multiple problems a focus on pure medical barriers is too narrow, because personal, social, and environmental factors might also obstruct participation in work.

Disabled but not deserving? The perceived deservingness of disability welfare benefit claimants

While disability benefits make up the largest group of claimants in high-income countries, we know surprisingly little about which disabled people are seen as ‘deserving’ benefits, nor whether different people in different countries judge deservingness-related characteristics similarly. This is surprising given they are increasingly the focus of retrenchment, which often affirms the deservingness of ‘truly deserving’ disabled people while focusing cuts and demands on those ‘less deserving’. This article addresses this gap using two vignette-based factorial survey experiments: (i) the nine-country ‘Stigma in Global Context – Mental Health Study’ (SGC-MHS); (ii) a new YouGov survey in Norway/the UK, together with UK replication. I find a hierarchy of symptoms/impairments, from wheelchair use (perceived as most deserving), to schizophrenia and back pain, fibromyalgia, depression and finally asthma (least deserving). Direct manipulations of deservingness-related characteristics also influence judgements, including membership of ethnic/racial ingroups and particularly blameworthiness and medical legitimation. In contrast, the effects of work ability, age and work history are relatively weak, particularly when compared to the effects on unemployed claimants. Finally, for non-disabled unemployed claimants, I confirm previous findings that right-wingers respond more strongly to deservingness-related characteristics, but Norwegians and Britons respond similarly. For disabled claimants, however, the existing picture is challenged, with, for example, Britons responding more strongly to these characteristics than Norwegians. I conclude by drawing together the implications for policy, particularly the politics of disability benefits, the role of medical legitimation and the legitimacy challenges of the increasing role of mental health in disability benefit recipiency.

Health service use of Australian unemployment and disability benefit recipients: a national, cross-sectional study

BackgroundHealthcare is funded and delivered separately from income support programs such as unemployment and disability benefits. Greater understanding of the health service use (HSU) of benefit recipients would support more effective design and delivery of health and income support programs. This study aimed to characterise the HSU of disability and unemployment benefit recipients relative to people earning wages, while controlling for personal, household and health-related factors associated with HSU in benefit recipients.MethodsA cross-sectional national survey of 9110 working age Australian adults in three groups: (1) 566 receiving the disability support pension (DSP); (2) 410 receiving unemployment benefits; and (3) 8134 earning wages. Outcomes included prevalence and frequency of health professional consultations, hospital attendance and admission in the past 12 months, as well as medication and supplement use in the past 2 weeks. Analyses compared DSP and unemployment benefit recipients to wage earners using prevalence ratios and incident rate ratios, adjusted for predisposing, enabling and need factors that may affect HSU.ResultsIn adjusted regression models, both DSP and unemployment benefit recipients were significantly more likely than wage earners to have consulted psychologists and social workers. DSP recipients also reported a significantly higher prevalence of consultations with General Practitioners (GPs), specialist physicians and podiatrists.. Both groups reported significantly more frequent consultations with GPs and DSP recipients with specialists. No differences were observed between groups for hospital attendance or admission, or supplement use in fully adjusted models, though the DSP group reported more prevalent medication use than wage earners. Inclusion of confounders including self-assessed health, disability severity, health insurance status, and financial resources attenuated the relationship between benefit receipt and HSU, however significant associations were still observed.ConclusionsPeople receiving unemployment and disability insurance benefits use significantly more health services than wage earners. A range of personal and clinical characteristics explained much, but not all, of the association between greater HSU and benefit receipt. Greater coordination between health and income support systems may improve health, reduce HSU and improve work ability in unemployed and working age people.

Research of features of statistical accounting of primary disability of the adult population in Russia

Disability of the population is one of the most topical challenges to society in the context of demographic aging of the population. To ensure the most effective response to this challenge, reliable information is needed about the health status of the population and the actual extent of disability in the main socio-demographic groups. In Russia, the study of disability issues is devoted to the works of many researchers, performed in the framework of medical, sociological and economic disciplines. Special attention is paid to the structure and dynamics of disability in the country as a whole and in its regions. At the same time, a special feature of the Russian system of statistical accounting for the number of disabled people is its focus on registering recipients of pensions and disability benefits, as well as on data on citizensʼ requests for identification of a disability group. This makes it difficult to assess the real extent of disability, because a part of the population is not included in the number of disabled. At the same time, the extent of accounting errors depends, inter alia, on the rules and criteria for determining disability established by the state. Taking into account these theses, the purpose of this study is the evaluation of the impact of social policy on the dynamics and structure of primary disability in the adult population of the Russian Federation. The information base of the study was made up of research data on similar topics, data from international organizations, and data from Russian state statistics. The paper summarizes and analyzes information about the number and structure of the disabled population, the dynamics of primary disability indicators, and the populationʼs requests for identification of a disability group. The main changes in the legislation regulating the procedure and criteria for recognizing citizens as disabled are analyzed. It is shown that a sharp increase in primary disability in 2005 was due to an increase in the number of applications for disability by citizens of retirement age. The main incentives were the monetization of benefits, changes in disability criteria and rules for pension provision for disabled people. It is proved that the registered indicators of primary disability depend on the reaction of the population to the social policy of the state, and this reaction is differentiated by socio-demographic groups of the population.ʼ

Long-Term Effects of Individual Placement and Support Services for Disability Benefits Recipients with Severe Mental Illnesses

This paper examines a broad set of short- and long-term impacts of Individual Placement and Support (IPS) for disability benefit recipients with severe mental disabilities. IPS is a specific intervention that first aims to place an individual in employment and subsequently trains the worker on the job. We compare the outcomes for IPS-recipients to a control group that received traditional vocational rehabilitation (TVR) services. We use administrative data to apply difference-in-difference estimation on a matched sample of 513 IPS recipients and almost 23,000 TVR-recipients in the Netherlands. Our results show that from six months after the start of the treatment onwards employment probabilities of IPS participants significantly outperform those of TVR participants. The higher probability to be in competitive employment does not come at the expense of fewer work in sheltered employment or trial periods. Nor do they come at the expense of shorter working hours or lower wages. The share of people on disability benefits declines equally in both group for quite some time after the start of the intervention but there is some indication that the benefit dependency in the long run declines faster for IPS recipients. Effects regarding medical costs are not statistically significant.

Labour Market Participation for Young People with Disabilities: The Impact of Gender and Higher Education

To what extent does higher education promote labour market participation for disabled people in school-to-work transitions and early career trajectories? This article argues that the effect of higher education on labour market outcomes for disabled people must be studied in correlation to gender. Intersectional theory warns against the generalisability of the female and male experiences, and predicts that disability may influence sexism, and that gender may influence disableism. Norwegian full-population register data on recipients of disability benefits are used to explore the effect of higher education on three labour market outcomes for men and women with disabilities. Contrary to common intersectionality expectations, the results show that men experience more extreme employment disadvantages related to their disabilities than women. Higher education has a stronger effect on participation for disabled women than for disabled men. However, gender differences in participation are smaller for people with disabilities than for the general population.

Can Helping the Sick Hurt the Able? Incentives, Information and Disruption in a Welfare Reform

Abstract The UK Jobcentre Plus reform sharpened bureaucratic incentives to help disability benefit recipients (relative to unemployment insurance recipients) into jobs. In the long run, the policy raised exits off diasability benefits by 10% and left unemployment outflows roughly unchanged, consistent with (i) beneficial effects of reorganising welfare offices for both groups, and (ii) a shift in bureaucrats' efforts towards getting disability benefit recipients into jobs relative to those on unemployment benefit. The policy accounted for about 30% of the decline in the aggregate disability rolls between 2003 and 2008. In the short run, however, we detect a reduction in unemployment exits and no effect on disability exits, suggesting important initial disruption effects from the big reorganisation. This highlights the difficulty of welfare reform as policymakers may focus on the short-run political costs rather than the long-run economic benefits.

Functional limitations and employment among disability benefit recipients with musculoskeletal conditions: A mediation analysis

This paper uses the National Beneficiary Survey to study the relationship between functional limitations, health conditions and employment among disability beneficiaries with musculoskeletal conditions in a multivariate mediation analysis.

Social participation and psychosocial outcomes of young adults with chronic physical conditions: Comparing recipients and non-recipients of disability benefits

BackgroundLittle is known about any differences between young people with chronic physical conditions who do and do not apply for disability benefits in young adulthood for providing insights for future policy and rehabilitation care. ObjectiveWe aimed to identify predictors during adolescence of receiving disability benefits in young adulthood and to compare recipients and non-recipients of benefits in social participation and psychosocial outcomes in young adulthood. MethodsFollow-up study of 18 to 25 year olds with various chronic conditions who at adolescent age completed a web-based survey (n=518; T0). The outcome was receiving disability benefits (yes or no). Associations with background characteristics, social participation, and impact of the chronic condition were explored with stepwise multivariate modelling, using T0 variables. Differences between recipients and non-recipients were explored using chi-square tests and t-tests. ResultsReceiving disability benefits in young adulthood was associated with greater extent of physical disability, receiving less special education, absenteeism at school/work, and low health-related quality of life during adolescence. In young adulthood, recipients of benefits reported higher perceived impact of the chronic condition on their school/work career and lower quality of life than non-recipients. Social participation varied across domains. ConclusionThis study provides important insights into the characteristics of a vulnerable subgroup of young people with chronic physical conditions. Disability benefit recipients experienced more impact of their chronic condition and reported a lower health-related quality of life over time than non-recipients. Rehabilitation professionals are encouraged to use patient-reported outcomes to address the lived experiences and screen the need for psychosocial support of this vulnerable subgroup of young people with chronic physical conditions.

Frequency of ocular diseases among recipients of disability benefits in the metropolitan region of Recife, Brazil.

To identify the frequency of ocular diseases among recipients of disability benefits in the metropolitan region of Recife, Brazil. A review was performed of 217,221 cases of disability benefits granted between 2010 and 2015 by the executive managerial department of the Brazilian National Institute of Social Security (Instituto Nacional do Seguro Social [INSS]) in Recife, which encompasses 14 municipalities of the metropolitan region, including the capital. The frequencies of the identified cases of ocular morbidity were then determined according to their group in the International Classification of Diseases, 10th Revision (ICD-10), their cause, the age, sex, and income of the recipient, and the type and duration of the benefit. Of all disability benefits granted, 5,324 (2.5%) were due to ocular disease, the majority (91.1%) consisting of sick pay. Most of the beneficiaries (64.6%) were males, were 20 to 59 years of age, and 61.2% earned the minimum wage or less. The principal ocular diseases for which sick pay benefits were granted were cataract (24.5%), conjunctivitis (21.1%), and pterygium (8.8%). Blindness and low vision were the principal ocular diseases in cases of accident indemnity and disability retirement. The results highlight the magnitude of the problem of ocular diseases to the social security system, with serious economic and social losses, and emphasize the need for measures aimed at their prevention. Moreover, integration between the national departments of health and social security needs to be improved.

Socioeconomic Inequalities in Psychological Distress among Urban Adults: The Moderating Role of Neighborhood Social Cohesion.

BackgroundVarious studies have reported socioeconomic inequalities in mental health among urban residents. This study aimed at investigating whether neighborhood social cohesion influences the associations between socio-economic factors and psychological distress.MethodsCross-sectional questionnaire study on a random sample of 18,173 residents aged 16 years and older from 211 neighborhoods in the four largest cities in the Netherlands. Psychological distress was the dependent variable (scale range 10–50). Neighborhood social cohesion was measured by five statements and aggregated to the neighborhood level using ecometrics methodology. Multilevel linear regression analyses were used to investigate cross-level interactions, adjusted for neighborhood deprivation, between individual characteristics and social cohesion with psychological distress.ResultsThe mean level of psychological distress among urban residents was 17.2. Recipients of disability, social assistance or unemployment benefits reported higher psychological distress (β = 5.6, 95%CI 5.2 to 5.9) than those in paid employment. Persons with some or great financial difficulties reported higher psychological distress (β = 3.4, 95%CI 3.2 to 3.6) than those with little or no financial problems. Socio-demographic factors were also associated with psychological distress, albeit with much lower influence. Living in a neighborhood with high social cohesion instead of low social cohesion was associated with a lower psychological distress of 22% among recipients of disability, social assistance or unemployment benefits and of 13% among citizens with financial difficulties.ConclusionsResiding in socially cohesive neighborhoods may reduce the influence of lack of paid employment and financial difficulties on psychological distress among urban adults. Urban policies aimed at improving neighborhood social cohesion may contribute to decreasing socio-economic inequalities in mental health.

The impact on health of employment and welfare transitions for those receiving out-of-work disability benefits in the UK

Employment status has a dynamic relationship with health and disability. There has been a striking increase in the working age population receiving out-of-work disability benefits in many countries, including the UK. In response, recent UK welfare reforms have tightened eligibility criteria and introduced new conditions for benefit receipt linked to participation in return-to-work activities. Positive and negative impacts have been suggested but there is a lack of high quality evidence of the health impact when those receiving disability benefits move towards labour market participation. Using four waves of the UK’s Understanding Society panel survey (2009–2013) three different types of employment and welfare transition were analysed in order to identify their impact on health. A difference-in-difference approach was used to compare change between treatment and control groups in mental and physical health using the SF-12. To strengthen causal inference, sensitivity checks for common trends used pre-baseline data and propensity score matching. Transitions from disability benefits to employment (n = 124) were associated on average with an improvement in the SF12 mental health score of 5.94 points (95% CI = 3.52–8.36), and an improvement in the physical health score of 2.83 points (95% CI = 0.85–4.81) compared with those remaining on disability benefits (n = 1545). Transitions to unemployed status (n = 153) were associated with a significant improvement in mental health (3.14, 95% CI = 1.17–5.11) but not physical health. No health differences were detected for those who moved on to the new out-of-work disability benefit. It remains rare for disability benefit recipients to return to the labour market, but our results indicate that for those that do, such transitions may improve health, particularly mental health. Understanding the mechanisms behind this relationship will be important for informing policies to ensure both work and welfare are ‘good for health’ for this group.

Financial work incentives for disability benefit recipients: lessons from a randomised field experiment

Abstract Disability insurance (DI) beneficiaries lose part or all of their benefits if earnings exceed certain thresholds (“cash-cliffs”). This implicit taxation is considered the prime reason for the low number of beneficiaries who expand work and reduce benefit receipt. We analyse a conditional cash programme that incentivises work related reductions of disability benefits in Switzerland. Four thousand DI beneficiaries received an offer to claim up to CHF 72,000 (USD 77,000) if they expand work and reduce benefits. Initial reactions to the programme announcement, measured by call-back rates, are modest. By the end of the field phase, the take-up rate is only 0.5 %.

Do the bullies survive? A five-year, three-wave prospective study of indicators of expulsion in working life among perpetrators of workplace bullying.

In recent series of studies, we have shown that targets of workplace bullying are at risk of expulsion in working life, both from current employment (e.g. in terms of changing employer) and from working life itself (e.g. becoming unemployed). The most recent of these, Take It or Leave: A Five-Year Prospective Study of Workplace Bullying and Indicators of Expulsion in Working Life was recently published in Industrial Health, and the present short communication aims to follow up that paper, investigating the possible job “survival” of the perpetrators. A nationally representative sample was employed (n=1,613), and responses were gathered at three time points with a two-year and a five-year time-lag. Outcomes were intention to leave and sickness absence at T1, and sickness absence, change of employer, disability benefit recipiency and unemployment at T2 and T3. The results of regression analyses clearly indicate that the perpetrators’ occupational status is largely unchanged, and remains so over time, as opposed to earlier findings regarding the targets of bullying.