Showing papers on "Disability insurance published in 2017"

Supplemental Nutrition Assistance Program (SNAP) Participation and Health Care Expenditures Among Low-Income Adults

Abstract: Importance Food insecurity is associated with high health care expenditures, but the effectiveness of food insecurity interventions on health care costs is unknown. Objective To determine whether the Supplemental Nutrition Assistance Program (SNAP), which addresses food insecurity, can reduce health care expenditures. Design, Setting, and Participants This is a retrospective cohort study of 4447 noninstitutionalized adults with income below 200% of the federal poverty threshold who participated in the 2011 National Health Interview Survey (NHIS) and the 2012-2013 Medical Expenditure Panel Survey (MEPS). Exposures Self-reported SNAP participation in 2011. Main Outcomes and Measures Total health care expenditures (all paid claims and out-of-pocket costs) in the 2012-2013 period. To test whether SNAP participation was associated with lower subsequent health care expenditures, we used generalized linear modeling (gamma distribution, log link, with survey design information), adjusting for demographics (age, gender, race/ethnicity), socioeconomic factors (income, education, Social Security Disability Insurance disability, urban/rural), census region, health insurance, and self-reported medical conditions. We also conducted sensitivity analyses as a robustness check for these modeling assumptions. Results A total of 4447 participants (2567 women and 1880 men) were enrolled in the study, mean (SE) age, 42.7 (0.5) years; 1889 were SNAP participants, and 2558 were not. Compared with other low-income adults, SNAP participants were younger (mean [SE] age, 40.3 [0.6] vs 44.1 [0.7] years), more likely to have public insurance or be uninsured (84.9% vs 67.7%), and more likely to be disabled (24.2% vs 10.6%) ( P Conclusions and Relevance SNAP enrollment is associated with reduced health care spending among low-income American adults, a finding consistent across several analytic approaches. Encouraging SNAP enrollment among eligible adults may help reduce health care costs in the United States.

Workplace stress, burnout and coping: a qualitative study of the experiences of Australian disability support workers.

Abstract: Disability support workers (DSWs) are the backbone of contemporary disability support services and the interface through which disability philosophies and policies are translated into practical action. DSWs often experience workplace stress and burnout, resulting in a high turnover rate of employees within the non-professional disability service workforce. The full implementation of the National Disability Insurance Scheme in Australia is set to intensify the current challenges of attracting and retaining DSWs, as the role becomes characterised by greater demands, ambiguity and conflict. The aim of this study was to explore DSWs' perceptions of enjoyable and challenging aspects of disability support work, sources of stress and burnout and the strategies they use to cope when these issues arise. Twelve DSWs workers providing support for adults living with intellectual and physical disabilities were interviewed. Thematic analysis revealed a superordinate theme of ‘Balance’ comprising three sub-themes: ‘Balancing Negatives and Positives’, ‘Periods of Imbalance’, and ‘Strategies to Reclaim Balance’. Participants spoke of the rewarding and uplifting times in their job such as watching a client learn new skills and being shown appreciation. These moments were contrasted by emotionally and physically draining aspects of their work, including challenging client behaviour, earning a low income, and having limited power to make decisions. Participants described periods of imbalance, wherein the negatives of their job outweighed the positives, resulting in stress and sometimes burnout. Participants often had to actively seek support and tended to rely on their own strategies to manage stress. Findings suggest that organisational support together with workplace interventions that support DSWs to perceive the positive aspects of their work, such as acceptance and mindfulness-based approaches, may help to limit experiences of stress and burnout. The further development and evaluation of emotion-focused workplace therapies, and interventions that consider organisational (macro) factors is suggested.

Predicting Employment in the Mental Health Treatment Study: Do Client Factors Matter?

Abstract: For people with psychiatric disabilities, demographic characteristics and measures of clinical status are often used to allocate scarce employment services. This study examined a battery of potential client predictors of competitive employment, testing the hypothesis that evidence-based supported employment would mitigate the negative effects of poor work history, uncontrolled symptoms, substance abuse, and other client factors. In a secondary analysis of 2055 unemployed Social Security Disability Insurance beneficiaries with schizophrenia or affective disorders, we examined 20 baseline client factors as predictors of competitive employment. The analysis used logistic regression to identify significant client predictors and then examined interactions between significant predictors and receipt of evidence-based supported employment. Work history was a strong predictor of employment, and other client measures (fewer years on disability rolls, Hispanic ethnicity, and fewer physical health problems) were modestly predictive. Evidence-based supported employment mitigated negative client factors, including poor work history. Participants with a poor work history benefitted from supported employment even more than those with a recent work experience. Evidence-based supported employment helps people with serious mental illness, especially those with poor job histories, to obtain competitive employment. Factors commonly considered barriers to employment, such as diagnosis, substance use, hospitalization history, and misconceptions about disability benefits, often have little or no impact on competitive employment outcomes.

Temporary Disability and Economic Incentives

Abstract: We investigate the impacts of economic incentives on the duration and outcome of temporary disability insurance (TDI) spells. The analysis is based on a large quasi-experiment taking place in Norway, involving a complete overhaul of the TDI benefit system. Our findings show that the labour supply of TDI claimants does respond to both the benefit level and the level of local labour demand. The estimated elasticity of the transition rate to employment with respect to the benefit level is -0.33. We also find that the TDI benefit level significantly affects the transition rate to alternative social insurance programmes.

The Effect of Disability Insurance Payments on Beneficiaries’ Earnings

Abstract: A crucial issue is whether social insurance affects work decisions through income or substitution effects. We examine this in the context of US Social Security Disability Insurance (DI), e...

The Financial Impact of Advanced Kidney Disease on Canada Pension Plan and Private Disability Insurance Costs.

Abstract: Background:Many working-age individuals with advanced chronic kidney disease (CKD) are unable to work, or are only able to work at a reduced capacity and/or with a reduction in time at work, and re...

Early Interventions and Disability Insurance: Experience from a Field Experiment *

Abstract: This paper estimates the effects of early interventions in the Swedish sickness insurance system. The aim of the interventions is to screen and, further to, rehabilitate sick listed individuals. We find that the early interventions – in contrast to what is expected – increase the inflow into disability benefits by around 20 percent. In order to explain the results, we develop a simple theoretical model based on asymmetric information of the health status. The model predicts that the treatment effect is larger for individuals with low incentives to return to work. In order to test this prediction we estimate effects for sick listed employed and unemployed separately. Consistent with the model’s prediction, we find that the effect is larger for the unemployed than for the employed.

Parents’ experiences in registering with and accessing funding under the National Disability Insurance Scheme for early intervention services for children with developmental disabilities

Abstract: Aim To evaluate parents’ feedback regarding their experience in registering and accessing funding with the National Disability Insurance Scheme (NDIS) and communicating with the National Disability Insurance Agency (NDIA). Methods Parents of children less than 7 years of age, who were assessed through the Child Development Unit (CDU) at the Women's and Children's Health Network from July 2013 to June 2014 and referred to the NDIS, were invited to complete a study questionnaire regarding their experience with the NDIS. The questionnaire was initially mailed to the parents. If no response was returned, families were telephoned to complete the questionnaire by phone or to be sent another copy of the questionnaire to complete. Results Of 121 children eligible for the study, 42 (34.7%) parents completed the questionnaire. Thirty-six (85.7%) parents reported having no difficulty with the NDIS registration process, while six parents (14.3%) had difficulty. With regards to accessing funding, 27 (64.3%) reported having no difficulty, 11 (26.2%) stated that it was difficult and 4 parents did not comment. Twenty-six parents (61.9%) reported that it was easy to communicate with the NDIA, while 12 (28.6%) found it difficult. Overall, 26 (61.9%) parents were satisfied with the NDIS and NDIA, 6 (14.8%) were unsatisfied and 9 (21.4%) were neutral. Conclusion The majority of parents were satisfied with both the processes required to register and access funding through the NDIS for early intervention services for their children with developmental disabilities, and their ability to communicate with the NDIA.

Reasonable, necessary and valued: pricing disability services for quality support and decent jobs

Abstract: This report is concerned with prospects for quality services and decent jobs under Australia's National Disability Insurance Scheme (NDIS) Specifically, it examines how the prices set by the National Disability Insurance Agency (NDIA) are: - affecting disability support workers; - enabling employers of disability support workers to meet their industrial obligations; and - supporting development of a skilled, high-quality, and decently remunerated disability support workforce

Characteristics and Employment of Applicants for Social Security Disability Insurance over the Business Cycle

Abstract: We investigate the relationship between the unemployment rate and characteristics of applicants for Social Security Disability Insurance using administrative records of the universe of applicants between 1991 and 2008. As the unemployment rate rises, applications shift to those with higher work capacity who are rejected early in the eligibility determination process and have higher pre-application earnings and employment. However, post-application earnings and employment of denied applicants are slightly negatively related to the unemployment rate, suggesting that both compositional changes toward applications with higher work capacity and adverse economic conditions affect their employment and earnings.

Cost-effectiveness of national health insurance programs in high-income countries: A systematic review.

Abstract: Objectives National health insurance is now common in most developed countries. This study reviews the evidence and synthesizes the cost-effectiveness information for national health insurance or disability insurance programs across high-income countries. Data sources A literature search using health, economics and systematic review electronic databases (PubMed, Embase, Medline, Econlit, RepEc, Cochrane library and Campbell library), was conducted from April to October 2015. Study selection Two reviewers independently selected relevant studies by applying screening criteria to the title and keywords fields, followed by a detailed examination of abstracts. Data extraction Studies were selected for data extraction using a quality assessment form consisting of five questions. Only studies with positive answers to all five screening questions were selected for data extraction. Data were entered into a data extraction form by one reviewer and verified by another. Evidence synthesis Data on costs and quality of life in control and treatment groups were used to draw distributions for synthesis. We chose the log-normal distribution for both cost and quality-of-life data to reflect non-negative value and high skew. The results were synthesized using a Monte Carlo simulation, with 10,000 repetitions, to estimate the overall cost-effectiveness of national health insurance programs. Results Four studies from the United States that examined the cost-effectiveness of national health insurance were included in the review. One study examined the effects of medical expenditure, and the remaining studies examined the cost-effectiveness of health insurance reforms. The incremental cost-effectiveness ratio (ICER) ranged from US$23,000 to US$64,000 per QALY. The combined results showed that national health insurance is associated with an average incremental cost-effectiveness ratio of US$51,300 per quality-adjusted life year (QALY). Based on the standard threshold for cost-effectiveness, national insurance programs are cost-effective interventions. Conclusions Although national health insurance programs have been introduced in most developed countries, only a few studies have examined their cost-effectiveness. All the selected studies revealed strong evidence to support health insurance programs or health reforms in the United States. The average ICER in this study is below the standard threshold for cost-effectiveness used in the US. The small number of relevant studies is the main limitation of this study.

Making every Australian count: challenges for the National Disability Insurance Scheme (NDIS) and the equal inclusion of homeless Aboriginal and Torres Strait Islander Peoples with neurocognitive disability.

Abstract: This article highlights the dearth of accurate evidence available to inform the National Disability Insurance Scheme (NDIS) regarding the extent and nature of neurocognitive disability amongst homeless Aboriginal and Torres Strait Islander people. Without accurate prevalence rates of neurocognitive disability, homeless Aboriginal and Torres Strait Islander people are in danger of not being counted by the NDIS and not receiving supports to which they are entitled. Addressing this knowledge gap is challenged by a range of factors, including: (1) the long-term effect of profound intergenerational disenfranchisement of Aboriginal and Torres Strait Islander people; (2) Aboriginal and Torres Strait Islander cultural perspectives around disability; (3) the generally unrecognised and poorly understood nature of neurocognitive disability; (4) the use of research methods that are not culturally safe; (5) research logistics; and (6) the absence of culturally appropriate assessment tools to identify prevalence. It is argued that an accurate evidence base that is informed by culturally safe research methods and assessment tools is needed to accurately guide the Commonwealth government and the National Disability Insurance Agency about the expected level of need for the NDIS. Research within this framework will contribute to the realisation of a truly inclusive NDIS.

How Income Changes During Unemployment: Evidence from Tax Return Data

Abstract: We use a panel of tax returns spanning 1999 to 2011 to provide evidence on household experiences during unemployment. A period of unemployment is associated with a 20 percent reduction in annual household wage earnings. Unemployment insurance (U.I.) compensates for half of lost wages. Households also partially compensate using a variety of income sources. Distributions from retirement accounts increase in the short run. Self-employment income and disability insurance payments increase over longer periods. More generous U.I. benefits crowd out wage income and are associated with increased retirement account distributions. This combination of responses is consistent with U.I. benefits lengthening unemployment spells.

Supplemental Security Income and the Transition to Adulthood in the United States: State Variations in Outcomes Following the Age-18 Redetermination

Abstract: Policy makers have raised concerns about the outcomes of former child Supplemental Security Income (SSI) recipients following the redetermination of eligibility at age 18 using an adult disability definition. We use Social Security administrative data to track state-level benefit receipt and employment outcomes of all former child SSI recipients who received an age-18 redetermination from 1998 through 2006, through age 24. We find that (1) state cessation rates ranged from 20 to 47 percent, (2) ceased recipients had higher employment rates and lower rates of SSI receipt than continued recipients, and (3) continued recipients who lived in states with higher employment rates also had higher Disability Insurance benefit receipt rates than those who lived in states with lower employment rates. The findings raise questions about the state-level variation in SSI’s role in the overall safety net and the variations in options available to former child SSI recipients following the age-18 redetermination.

[Assement of incapacity to work and the Mini-ICF-APP].

Abstract: Objective According to recent recommendations the Mini-ICF Rating for Limitations of Activities and Participation in Psychological Disorders (Mini-ICF-APP) should be used in the assessment of incapacity to work. However evidence from empirical research in the field is missing. Methods The application of the Mini-ICF-APP in the psychiatric assessment of 121 cases was analysed. Results A significant correlation between capacity to work and the duration of sick-leave with the Mini-ICF-APP sum-score was confirmed. The probability that criteria for disability insurance compensations was fulfilled according to the assessor increased with the Mini-ICF-APP-sum-score. Conclusion Our study provides first empirical evidence regarding the application of the Mini-ICF-APP in the psychiatric assessment of incapacity to work.

Economic Conditions and Supplemental Security Income Application

Abstract: IntroductionOver the last 30 years, the Supplemental Security Income (SSI) program, which provides federally funded income support for individuals with disabilities, has become one of the most important means-tested cash aid programs in the United States. In 2015, SSI provided payments to 4.9 million low-income adults aged 18-64 who met its disability criteria (Social Security Administration [SSA] 2017a, Table 7.A1). That figure represents a doubling in the adult SSI caseload since 1990 (Chart 1). The federal government spent $46.9 billion on payments to SSI recipients with disabilities in 2015 (SSA 2017a, Table 7.A4), representing a 155 percent increase in real dollars since 1990.1Because SSI is a means-tested program, one might expect application trends to be countercyclical-decreasing when the economy is expanding and increasing during recessions. However, the cyclicality of application has varied over time. Chart 2 graphs SSI applications for adults aged 18-64 (leftaxis) against the unemployment rate (right axis) for 1990-2015. For most of the period-from 1990 through about 2002 and from 2008 to 2015-the trend in SSI application followed the trend in the national unemployment rate fairly closely. For example, the steady decline in SSI application in the 1990s began about 1 year after the unemployment rate began to decline; SSI application increased as unemployment rates rose during the Great Recession of 2008-2010 and application declined during the subsequent recovery. However, the 2003-2007 period presents an anomaly: Although the unemployment rate fell, SSI application continued to rise. Rutledge and Wu (2014) offer a number of explanations for the continuing rise in applications during that period, including the lagged effects of prior welfare reforms that induced Temporary Assistance for Needy Families (TANF) program participants to switch to SSI, persistently high poverty rates, and increases in the share of the population in fair or poor health.A number of previous studies looked at the effects of economic conditions on growth in disability program caseloads. However, much of that work focused on Social Security Disability Insurance (DI), which is limited to individuals who meet that program's earnings-history thresholds and who therefore may be more responsive to economic conditions. Most research focusing specifically on SSI dates from the 1990s. Those studies found that higher unemployment was associated with increases in SSI application and caseloads (Rupp and Stapleton 1995; Stapleton and others 1998; Stapleton and others 1999). The relationship between economic conditions and SSI application may have evolved significantly since then. Given rapid growth in the SSI rolls and the slow pace of recovery from the Great Recession, understanding the role that business cycles play in determining SSI participation has become increasingly important.In this article, we examine the relationship between economic conditions and working-age adult SSI application from 1996 through 2010 using data from the Survey of Income and Program Participation (SIPP) linked to SSA's 831 data file. These restricted-access data allow us to link detailed SIPP information on demographic conditions and unemployment spells with precise SSA records on the month of first application for SSI and DI benefits. Using hazard models, we estimate SSI and DI application risk among individuals who were working when first observed in the SIPP but were unemployed during follow-up surveys in their respective SIPP panels, and examine the effect of the unemployment rate both at the time of job loss (the baseline rate) and at the time of-that is, contemporaneous with-SSI application. Whereas the contemporaneous measure reflects local labor market conditions at the time of application, the baseline rate may reflect differential characteristics of the pool of unemployed workers related to the business cycle. Our results suggest that application risk increases significantly with higher contemporaneous state unemployment rates. …

Beyond the Genetic Information Nondiscrimination Act: ethical and economic implications of the exclusion of disability, long-term care and life insurance.

Abstract: The Genetic Information Nondiscrimination Act (GINA) was intended to protect individuals in the USA from discrimination based on their genetic data, but does not apply to life, long-term care or disability insurance. Patient advocates and ethicists have argued that GINA does not go far enough. Others express concerns for the viability of insurance companies if millions of potential customers know more than professional actuaries. Here we discuss the exclusion of certain insurance types from GINA. We explore the ethical and economic implications of this distinction, and potential paths forward. We suggest that because long-term care and disability insurance can be essential for well-being, there is no good reason to place them in a class with life insurance and therefore beyond GINA's reach.

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

Abstract: 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.

Work Disability Among Native-born and Foreign-born Americans: On Origins, Health, and Social Safety Nets.

Abstract: Public debates about both immigration policy and social safety net programs are increasingly contentious. However, little research has explored differences in health within America’s diverse population of foreign-born workers, and the effect of these workers on public benefit programs is not well understood. We investigate differences in work disability by nativity and origins and describe the mix of health problems associated with receiving Social Security Disability Insurance benefits. Our analysis draws on two large national data sources—the American Community Survey and comprehensive administrative records from the Social Security Administration—to determine the prevalence and incidence of work disability between 2001 and 2010. In sharp contrast to prior research, we find that foreign-born adults are substantially less likely than native-born Americans to report work disability, to be insured for work disability benefits, and to apply for those benefits. Overall and across origins, the foreign-born also have a lower incidence of disability benefit award. Persons from Africa, Northern Europe, Canada, and parts of Asia have the lowest work disability benefit prevalence rates among the foreign-born; persons from Southern Europe, Western Europe, the former Soviet Union, and the Caribbean have the highest rates.

Medical Marijuana Laws and Disability Applications, Receipts, and Terminations

Abstract: We study the effect of state medical marijuana laws (MMLs) on disability claiming. MMLs allow qualifying patients to legally use marijuana for medical purposes. We examine Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) applications, new beneficiaries, and terminations. We use administrative data from the Social Security Administration coupled with a differences-in-differences design to study this question. We find that MML adoption increases application and new beneficiary rates, and reduces termination rates, although new beneficiary rate estimates are somewhat imprecise.

Does Disability Insurance Improve Health and Well-being?

Abstract: 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.

The expansion of public health insurance in Mexico: health, financial and distributional effects

Abstract: During the past decade, the Mexican government launched an ambitious expansion of public health insurance through the Seguro Popular programme (SP). As a result, health care access was legislated as citizens’ entitlement, a generous benefit package was offered, and public health expenditure was significantly increased. In 2011, the programme had reached 52 million affiliates. However, there is limited evidence on its effects on a number of outcomes and their distribution. This thesis analyses three aspects that are key to evaluate health system performance. Specifically, using quasi-experimental methods and recent distributional measures of pure health, it examines the effect of universal insurance coverage on infant mortality, non-medical consumption, and health inequalities. Drawing on municipality-level data, the first article finds that the programme led to a 3.9 per cent decrease in infant and neonatal mortality. These reductions were concentrated in more populated, urban, and less marginalised municipalities, however, probably because this type of municipalities have been traditionally better equipped and are thus better prepared to offer all the interventions from the benefit package. Based on data from the Mexican Family Life Survey (MxFLS), the second article shows that unexpected health events such as accidents and deterioration in physical capacity are associated with large declines in non-medical consumption. Social security seems to provide protection against both types of shocks, but endogeneity-corrected estimates show that the SP only protects consumption against accidents. This suggests that income losses associated with disability shocks for which the programme does not offer protection, are likely larger than medical care expenditures, and poses the question of whether other social security benefits, such as disability insurance, should also be extended. Finally, the third article analyses the distribution of health in the context of the SP implementation. Unlike traditional studies, pure health inequality and mobility are analysed using a recently developed class of indices appropriate for categorical data. If a downward-looking definition of status is employed, the distribution of health appears stable, but if an upward-looking definition is adopted, a significant increase in inequality is observed. Evidence of strong persistence in health was also found. This lack of improvement in the health distribution suggests that factors other than health insurance coverage, such as institutional performance, are more important determinants of health inequalities. Overall, this thesis finds important health effects from extending health insurance coverage but limited effects on economic welfare and the distribution of health status across the entire population.

Health, disability insurance and labour supply: evidence from a dynamic structural model

Abstract: This paper provides a quantitative assessment of the labour market and welfare effects of the disability insurance (DI) benefit. To this end, I develop a life-cycle model in which individuals choose consumption, labour supply and whether to claim for DI. The effects revealed by counterfactual policy simulations are largely heterogeneous by health; low-health and poor individuals place a higher value on DI. If there is a reduction in the benefit amount, only half of those who leave the benefit return to work. Policies that reduce the cost of re-entering the labour market by 10% increase the labour supply by 5.3 percentage points among DI recipients, without de-

E Xits from the Disability Insurance Rolls: Estimates from a Competing-Risks Model

Abstract: This article explores the causes of growth in the number of disabled workers on the Social Security Disability Insurance (DI) rolls from 1980 through 2010 by estimating the probability of a DI beneficiary's program exit because of recovery, death, or conversion to retired-worker beneficiary, by sex, age, and disability type. Using Social Security administrative data and a competing-risks model to estimate DI exit probabilities, I find that death is the primary reason for program exits among nearly all beneficiary subgroups during their first 9 years on the rolls. Relative to men, women have lower probabilities of exit because of death; younger women also have lower exit probabilities because of recovery. From the 1980s to the 1990s, the probability of exit because of death declined while the probability of exit because of recovery did not improve. Beneficiaries with certain impairments are noteworthy exceptions to these general outcomes. Introduction For the Social Security Disability Insurance (DI) program, the numbers of new enrollments and of beneficiaries on the rolls rose rapidly from 1980 through 2010. Clearly, growth in the DI rolls can result when the number of enrollments increases; but it may also result when beneficiaries stay longer in the program. Possible contributing factors include (1) demographic shifts, such as growing shares of younger and female workers entering the rolls; (2) changes in DI policies and in economic conditions (such as high unemployment) influencing workers to enter the program and stay longer in it; and (3) changing health trends, with certain disabling impairments (such as musculoskeletal impairments and mental disorders) becoming more prevalent among various population subgroups. A beneficiary's stay on the DI rolls also depends on individual characteristics such as the type of disability, age at entitlement, sex, employment opportunities, and past health conditions. Available administrative data do not have information on many of these individual characteristics. In this article, I focus on exit-rate patterns by age and sex, by type of disability, and over time, to examine if workforce shifts toward relatively younger workers, more female workers, or more aging workers prone to certain types of disabilities might explain the observed growth in the DI rolls. A DI beneficiary exits the program for one of three reasons--death, recovery, or conversion to retirement benefits at full retirement age (FRA). A recovery--leaving the program before death or old-age conversion--can be due either to a worker's return to employment that provides a substantial level of earnings or to a Disability Determination Service finding that a beneficiary is no longer disabled. This article does not distinguish between the two. The probability of exit because of a given cause depends on the probabilities of exit resulting from the competing causes. For instance, the probability of exiting DI because of recovery within a certain time depends on the likelihood that the person did not exit the program earlier because of either death or conversion. Thus, it is important to estimate the exit probabilities of any specific cause jointly with the exit probabilities of the two competing causes. Otherwise, we will have biased estimates (see, for instance, Pintilie 2006). I use a competing-risks statistical method that estimates the exit probabilities for all three competing risks simultaneously. Using these estimates, I present the emerging patterns of DI program exits by age at entitlement, sex, type of disability, and time on the rolls. Selected Abbreviations CWHS Continuous Work History Sample DI Disability Insurance FRA full retirement age A parametric or semiparametric competing-risks hazard model is more appropriate than a cell-frequency method to estimate exit probabilities for two reasons. First, as cells are divided more finely to enhance granularity, some of them may end up containing zero or very few observations. …

Firm-Level Early Intervention Incentives: Which Recent Employers of Disability Program Entrants Would Pay More?:

Abstract: The declining economic status of people with disabilities and the predicted 2016 depletion of the Social Security Disability Insurance (DI) Trust Fund have generated considerable interest in propos...

Disability Benefits, Consumption Insurance, and Household Labor Supply

Abstract: While a mature literature finds that Disability Insurance (DI) receipt discourages work, the welfare implications of these findings depend on two rarely studied economic quantities: the full cost of DI allowances to taxpayers, summing over DI transfer payments, benefit substitution to or from other transfer programs, and induced changes in tax receipts; and the value that individuals and families place on receiving benefits in the event of disability. We comprehensively assess these missing margins in the context of Norway's DI system, drawing on two strengths of the Norwegian environment. First, Norwegian register data allow us to characterize the household impacts and fiscal costs of disability receipt by linking employment, taxation, benefits receipt, and assets at the person and household level. Second, random assignment of DI applicants to Norwegian judges who differ systematically in their leniency allows us to recover the causal effects of DI allowance on individuals at the margin of program entry. Accounting for the total effect of DI allowances on both household labor supply and net payments across all public transfer programs substantially alters our picture of the consumption benefits and fiscal costs of disability receipt. While DI denial causes a significant drop in household income and consumption on average, it has little impact on income or consumption of married applicants; spousal earnings and benefit substitution entirely offset the loss in DI benefit payments. To develop the welfare implications of these findings, we estimate a dynamic model of household behavior that translates employment, reapplication and savings decisions into revealed preferences for leisure and consumption. We find that household valuation of receipt of DI benefits is considerably greater for single and unmarried individuals than for married couples because spousal labor supply substantially buffers household income and consumption in the event of DI denial.

‘The age of entitlement has ended’: designing a disability insurance scheme in turbulent times

Abstract: In a period of welfare state retrenchment, Australia’s neo-liberal government is continuing to implement an expensive National Disability Insurance Scheme (NDIS). Australia is among the pioneers of welfare measures funded from general revenue. Until recently, however, attempts to establish national schemes of social insurance have failed. The paper reviews this history through the lenses of path dependence accounts. It then presents contrasting descriptions of the NDIS by its Chair, the politician who inspired him, and two feminist policy analysts from a carers’ organisation. Path dependence, these accounts illustrate, has been broken in some respects but consolidated in others. In particular, the dynamics of ‘managed’ capitalist markets, gendered notions of abstract individuals and organisations, and the related difficulties in accounting for unpaid labour are constraining the transformative potential of the NDIS.

Characteristics of adults with psychiatric disabilities participating in the federal disability programs.

Abstract: Objective We use nationally representative data on working-age recipients of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) to profile beneficiaries with psychiatric disabilities and compare them with beneficiaries eligible for SSDI and SSI on the basis of other health conditions. Method Using data from 4 National Beneficiary Survey rounds, we conducted descriptive analyses of the personal and health characteristics and employment experiences of beneficiaries with and without psychiatric disabilities. Our sample includes 16,190 SSDI and SSI beneficiaries, of whom 6,447 have psychiatric disabilities. We conducted statistical tests of significance (χ2 and t statistics) to assess the difference between beneficiaries with and without psychiatric disabilities. Results Beneficiaries with psychiatric disabilities differ in many ways from other beneficiaries. They are significantly more likely to be younger than 55 years of age, female, have children, be unmarried, live alone, and be in poverty. Although a greater share report a desire to work, they are also more likely than their counterparts with other disabilities to report various employment barriers, including being discouraged by previous work attempts, the perception that others do not think they can work, a lack of transportation, and not wanting to lose cash or health insurance benefits. Conclusions and implications for practice The findings suggest that beneficiaries with psychiatric disabilities face numerous significant employment obstacles that would need to be addressed for supported employment or similar approaches to be successful. (PsycINFO Database Record

Supppplemental Security Income and Social Security Disability Insurance Beneficiaries with Intellectual Disability

Abstract: People with intellectual disability (ID) make up about 14 percent of all working-age Supplemental Security Income and Social Security Disability Insurance (DI) beneficiaries. Because of their disabilities, many face major employment challenges and often receive federal disability program benefits for several decades. This article describes these beneficiaries and compares them to those without ID. The two groups differ markedly in a number of ways; for example, those with ID are more likely to be working, but they also earn significantly less than other disability program beneficiaries. Their relatively low earnings, combined with low benefits, contribute to a higher overall rate of poverty--particularly among those who receive only DI. Introduction Intellectual disability (ID) is relatively uncommon; studies have estimated that less than 5 percent of the general population has ID (McKenzie and others 2016; Maulik and others 2011). Although the prevalence of ID is rare in the general population, people with ID make up a sizable share (about 14 percent) of the 13 million working-age Supplemental Security Income (SSI) and Social Security Disability Insurance (DI) beneficiaries. (1) ID is especially common among SSI recipients--more than one-fifth of them are eligible for payments because of ID. ID is typically diagnosed during childhood. As a result, many beneficiaries with ID enter the SSI or DI programs at a young age and receive benefits for decades. Children with ID make up about 9 percent of children enrolled in SSI (SSA 2015b), and the large majority of them (about 80 percent) continue to qualify for SSI payments after age 18 (Hemmeter and Gilby 2009). Riley and Rupp (2015) estimated that beneficiaries with ID remain in the disability programs as working-age adults for an average of 29 years--about twice the average for all disability program beneficiaries. This long tenure contributes to much higher average DI, SSI, Medicare, and Medicaid cumulative expenditures than the estimated average for all beneficiaries ($472,913 versus $292,401, in 2012 dollars) (Riley and Rupp 2015). Given their large number and long tenure on the disability rolls, beneficiaries with ID represent a potentially important target group for support services designed to enable community living, permit long-term employment, and reduce reliance on public benefits. Effective supports could also affect federal and state initiatives designed to promote employment opportunities for people with ID and developmental disabilities (DDs) in competitive, community-based employment, rather than in sheltered employment settings, where they earn low wages and remain segregated from mainstream society. Information on the characteristics and employment experiences of people with ID is limited because identifying people with ID in national surveys can be difficult (Emerson, Felce, and Stancliffe 2013; Hendershot and others 2005). In addition, the relatively low prevalence of ID in the general population makes it difficult to study a large sample. Most of the information about people with ID comes from administrative sources (such as state education, vocational rehabilitation, and DD agencies) and from special surveys (such as those conducted for the National Longitudinal Transition Study and the National Core Indicators [NCI] project, which use administrative data to identify individuals with ID). Our study adds to the existing information by profiling working-age adults with ID who receive SSI and DI benefits. We use data from several rounds of a large, nationally representative survey of SSI and DI beneficiaries to describe the personal characteristics, employment, and income sources of beneficiaries with ID, and we compare them with those of disability program beneficiaries with other impairments. Our findings provide a better understanding of the working-age population with ID that relies on federal disability program benefits, the employment challenges they face, and the differences in their employment experiences from SSI and DI beneficiaries with other significant disabilities. …