Showing papers on "Disability insurance published in 2018"

The Role of Information in Disability Insurance Application: An Analysis of the Social Security Statement Phase-In

Abstract: This paper exploits a natural experiment in information provision on US Disability Insurance (DI) applications: the Social Security statement. Although the effect of the statement on DI application was negligible in the general health and retirement study population, among those previously reporting a work limitation, biennial DI application rates approximately doubled. This effect was driven by previously uninformed individuals. Additional analyses show these were new applicants and were no less likely to be accepted onto DI, accounting for a substantial fraction of the rise in DI rolls from 1994 to 2004 and indicating the importance of informational frictions in disability policymaking.

Trends and Disparities in Leave Use under California's Paid Family Leave Program: New Evidence from Administrative Data

Abstract: We use novel administrative data to study trends and disparities in usage of California's first-in-the-nation paid family leave (PFL) program. We show that take-up for both bonding with a new child and caring for an ill family member increased over 2005–2014. Most women combine PFL with maternity leave from the State Disability Insurance system, resulting in leaves longer than 6 weeks. Most men take less than the full 6 weeks of PFL. Individuals in the lowest earnings quartile and in small firms are the least likely to take leave. There are important differences in take-up across industries, especially for men.

Annual Statistical Report on the Social Security Disability Insurance Program, 2011

Abstract: this annual report provides program and demographic information on the people who receive social security disability insurance program benefits this edition presents a series of detailed tables on the three categories of beneficiaries disabled workers disabled widowers and disabled adult children numbers presented in these tables may differ slightly from other published statistics because all tables except those using data from the survey of income and program participation are based on 100 percent data files

Assessing Factors Associated with Long-Term Work Disability After Cancer in Belgium: A Population-Based Cohort Study Using Competing Risks Analysis with a 7-year Follow-Up

Abstract: Objectives The number of workers with cancer has dramatically increasing worldwide. One of the main priorities is to preserve their quality of life and the sustainability of social security systems. We have carried out this study to assess factors associated with the ability to work after cancer. Such insight should help with the planning of rehabilitation needs and tailored programmes. Participants We conducted this register-based cohort study using individual data from the Belgian Disability Insurance. Data on 15 543 socially insured Belgian people who entered into the long-term work disability between 2007 and 2011 due to cancer were used. Primary and secondary outcome measures We estimated the duration of work disability using Kaplan-Meier and the cause-specific cumulative incidence of ability to work stratified by age, gender, occupational class and year of entering the work disability system for 11 cancer sites using the Fine and Gray model allowing for competing risks. Results The overall median time of work disability was 1.59 years (95% CI 1.52 to 1.66), ranging from 0.75 to 4.98 years. By the end of follow-up, more than one-third of the disabled cancer survivors were able to work (35%). While a large proportion of the women were able to work at the end of follow-up, the men who were able to work could do so sooner. Being women, white collar, young and having haematological, male genital or breast cancers were factors with the bestlikelihood to be able to return to work. Conclusion Good prognostic factors for the ability to work were youth, woman, white collar and having breast, male genital or haematological cancers. Reviewing our results together with the cancer incidence predictions up to 2025 offers a high value for social security and rehabilitation planning and for ascertaining patients’ perspectives.

Toward a Resident Personal Finance Curriculum: Quantifying Resident Financial Circumstances, Needs, and Interests.

Abstract: Introduction Resident financial health has been linked to wellness and resiliency, yet financial literacy among residents is highly variable. While some medical school curricula include budgeting and student loan education, content on managing finances as a resident is usually lacking. We sought to quantitatively assess residents' financial circumstances, needs, and interests to inform the design of a resident personal finance curriculum. Methods Surveys were sent to residents in eight specialties at an academic medical center. Likert-type responses allowed respondents to rate their level of comfort (1 = Very Uncomfortable, 7 = Very Comfortable) and interest (1 = Very Uninterested, 7 = Very Interested) in various personal finance topics including budgeting, loan repayment, disability insurance, life insurance, home buying, and retirement planning. Details regarding financial circumstances, including assets, liabilities, and insurance, were also collected. Results of questions that utilized a Likert-type scale are reported as median (interquartile range). Results Of 346 residents surveyed, 144 (41.6%) responded. Residents were from Internal Medicine (56, 38.9%), Pediatrics (34, 23.6%), Emergency Medicine (18, 12.5%), and other specialties (36, 25.0%). Ninety-one (63.2%) reported educational loans, with an average balance of $191,730. Credit card balances exceeding $3,000 were reported by 11 (7.6%) respondents. One-hundred-two (70.1%) reported emergency savings, but only 65 (45.1%) reported having a retirement account (average balance $27,608). Respondents rated highest comfort levels with budgeting (5[4-6]), and lowest level of comfort with disability insurance (2[2-4]) and home buying (2[2-5]). Interest in learning each topic was high (6[5-7]), with retirement planning (6[5-7]), investing (6[5-7]), and home buying (6[5-7]) the topics of highest interest. Conclusion These results highlight the deficits in personal finance literacy among residents. Future work should focus on development of a nationally scalable personal finance curriculum for residents.

The Impact of Affordable Care Act Medicaid Expansions on Applications to Federal Disability Programs

Abstract: In this paper, we estimate the impact of Medicaid expansions via the Patient Protection and Affordable Care Act (ACA) on applications to federal disability programs in 14 states that expanded Medicaid in January 2014. We use a difference-in-differences regression model to compare disability application rates in geographic areas within states that expanded Medicaid to rates in areas of non-expansion states that were carefully selected using a matching approach that accounts for state Medicaid policies pre-ACA as well as demographic and socioeconomic characteristics that might influence disability application rates. We find a slower decrease in Supplemental Security Income (SSI) application rates after Medicaid expansions in expansion states relative to non-expansion states, with application rates declining in both state groups from 2014 through 2016. Our analysis of the impact of the Medicaid expansions on Social Security Disability Insurance (SSDI) application rates was inconclusive for reasons we discuss in the paper.

Innovations in Occupational Health Care Delivery Can Prevent Entry into Permanent Disability: 8-Year Follow-up of the Washington State Centers for Occupational Health and Education.

Abstract: BACKGROUND Long-term work disability is known to have an adverse effect on the nation's labor force participation rate. To reduce long-term work disability, the Washington State Department of Labor and Industries established a quality improvement initiative that created 2 pilot Centers of Occupational Health and Education (COHE). OBJECTIVES To document the level of work disability in a sample of injured workers with musculoskeletal injuries and to examine (8-y) work disability outcomes associated with the COHE health care model. RESEARCH DESIGN Prospective nonrandomized intervention study with nonequivalent comparison group using difference-in-difference regression models. SUBJECTS Intervention group represents 18,790 workers with musculoskeletal injuries treated by COHE providers. Comparison group represents 20,992 workers with similar injuries treated within the COHE catchment area by non-COHE providers. MEASURES Long-term disability outcomes include: (1) on disability 5 years after injury; (2) received a state pension for total permanent disability; (3) received total disability income support through the Social Security Disability Insurance program; or (4) a combined measure including any one of the 3 prior measures. RESULTS COHE patients had a 30% reduction in the risk of experiencing long-term work disability (odds ratio=0.70, P=0.02). The disability rate (disability days per 1000 persons) over the 8-year follow-up for the intervention and comparison groups, respectively, was 49,476 disability days and 75,832 disability days. CONCLUSIONS Preventing long-term work disability is possible by reorganizing the delivery of occupational health care to support effective secondary prevention in the first 3 months following injury. Such interventions may have promising beneficial effects on reversing the nation's progressively worsening labor force participation rate.

Unequal Use of Social Insurance Benefits: The Role of Employers

Abstract: California's Disability Insurance (DI) and Paid Family Leave (PFL) programs have become important sources of social insurance, with benefit payments now exceeding those of the state's Unemployment Insurance program. However, there is considerable inequality in program take-up. While existing research shows that firm-specific factors explain a significant part of the growing earnings inequality in the U.S., little is known about the role of firms in determining the use of public leave-taking benefits. Using administrative data from California, we find strong evidence that DI and PFL program take-up is substantially higher in firms with high earnings premiums. A one standard deviation increase in the firm premium is associated with a 57 percent higher claim rate incidence. Our results suggest that changes in firm behavior have the potential to impact social insurance use and thus reduce an important dimension of inequality in America.

How do social security schemes and labor market policies support the return-to-work of cancer survivors? A review article

Abstract: Objective About 40% of new cancer diagnoses are detected among working age individuals. Cancer diagnosis and treatment have high impact on the work ability of workers and represent a real challenge for the healthcare and social security systems but also for employers and the labour market. This review aims at investigating the legal frameworks set up in EU Member States that support the retention and integration of workers with disability. Furthermore, we look at these initiatives or measures to see whether they fit the specific needs of workers with cancer. Methods We searched the PubMed database combining 4 key words: cancer, labour market, labour law and disability insurance or disability benefits. A total of 1.185 articles were found of which 10 were used for this review. In addition, grey literature, reports from the European Commission, the OECD and the WHO were searched and included in the material used for this review. Results Few peer reviewed articles discuss the impact of labor market law on the (re)integration of cancer survivors. Most measures and initiatives support workers with chronic diseases but present important limits when considering workers with cancer. Collaboration and coordination among health providers, social workers and employment decision makers is the mostly required and effective. Conclusion More research efforts should be made to systematically assess the impact of labor market and employment measures and initiatives on the (re)integration of workers with chronic diseases, with specific attention for workers with cancer. Legal frameworks need to be rethought for a better balance between productivity and equity, inclusion and social justice.

Costs, Risks and Responsibility. Negotiating the Value of Disabled Workers Between Disability Insurance and Employers

Abstract: Abstract Drawing on the theoretical framework of the Economics of Convention this paper analyses the employment of people with disabilities as a valuation process. Based on case studies and interviews in business companies and disability insurance offices, it explores how employers and disability insurance determine the value of disabled workers. Inasmuch as employers are not willing to adapt performance standards, job design and work organisation, disability insurance attains individual exceptions for its clients at best, while disabling standards remain intact.

Genetics, Insurance and Professional Practice: Survey of the Australasian Clinical Genetics Workforce.

Abstract: In Australia and New Zealand, by contrast with much of the developed world, insurance companies can use genetic test results to refuse cover or increase premiums for mutually-rated insurance products, including life, income protection and disability insurance. Genetics professionals regularly discuss insurance implications with clients and report the issue as a clinical challenge, yet no studies have examined clinical practices or opinions. This study surveyed genetic counsellors and clinical geneticists from Australia and New Zealand to (i) investigate variability in professional practice across the Australasian clinical genetic workforce relating to the insurance implications of genetic testing, and (ii) ascertain views regarding current regulation of the issue. There was considerable variability in training and clinical policies, especially around the communication of insurance implications. Almost half of participants reported receiving no training on the insurance implications of genetic testing, and almost 40% were unsure whether they could adequately advise clients. A number of deficits in professional knowledge and understanding of the issue were identified. Widespread concerns regarding regulation of this area were reported, with < 10% of Australian participants considering current Australian regulations as adequate to protect clients from genetic discrimination. The findings from this study highlight scope for greater education, consistency and professional training on the issue of genetics and insurance in Australasia, and strong agreement about the need for regulatory reform.

National Disability Insurance Scheme, health, hospitals and adults with intellectual disability.

Abstract: Preventable poor health outcomes for adults with intellectual disability in health settings have been known about for years. Subsequent analysis and the sorts of reasonable adjustments required in health and disability support settings to address these health gaps are well described, but have not really been embedded in practice in any significant way in either setting. As far as health is concerned, implementation of the National Disability Insurance Scheme (NDIS, the Scheme) affords an opportunity to recognise individual needs of people with intellectual disability to provide reasonable and necessary functional support for access to mainstream health services, to build capacity of mainstream health providers to supply services and to increase individual capacity to access services. Together these strands have potential to transform health outcomes. Success of the Scheme, however, rests on as yet incompletely defined operational interaction between NDIS and mainstream health services and inherently involves the disability sector. This interaction is especially relevant for adults with intellectual disability, known high users of hospitals and for whom hospital outcomes are particularly poor and preventable. Keys to better hospital outcomes are first, the receiving of quality person-centred healthcare from physicians and hospitals taking into account significance of intellectual disability and second, formulation of organised quality functional supports during hospitalisation. Achieving these require sophisticated engagement between consumers, the National Disability Insurance Agency, Commonwealth, State and Territory government leaders, senior hospital and disability administrators, NDIS service providers and clinicians and involves cross fertilisation of values, sharing of operational policies and procedures, determination of boundaries of fiscal responsibility for functional supports in hospital.

The Recent Rise of Labor Force Participation of Older Workers in Sweden

Abstract: This paper studies the background to the increase in labor force participation of older workers in Sweden since 2000. In the first part, we study how the characteristics of the elderly have changed with respect to health, education level and work environment, as well as the impact of joint decision-making within the household. In the second part, we study the importance of institutional changes, including a major reform of the old-age pension system, introduction of tax credits for older workers, changes of the mandatory retirement age and stricter eligibility criteria in the disability insurance program. We find that the rise in labor force participation has coincided with improvements in health and educational attainment across birth cohorts as well as increased screening stringency in the disability insurance program.

2018-7 The Disability Option: Labor Market Dynamics with Macroeconomic and Health Risks

Abstract: We evaluate the contribution of changing macroeconomic conditions and demographics to the increase in Social Security Disability Insurance (SSDI) over recent decades. Within our quantitative framework, multiple sectors differentially expose workers to health and economic risks, both of which affect individuals’ decisions to apply for SSDI. Over the transition, falling wages at the bottom of the distribution increased awards by 27% in the 1980s and 90s and aging demographics rose in importance thereafter. The model also implies two-thirds of the decline in working-age male employment from 1985 to 2013, three-fourths of which eventually goes on SSDI.

Layering, Kludgeocracy and Disability Rights: The Limited Influence of the Social Model in American Disability Policy

Abstract: The United States has been a leader in the creation of disability rights law, providing a policy template for other nations. Yet the social model, the animating philosophy behind the disability rights movement, has had little effect on the wide range of welfare programs that serve people with disabilities. These programs, whose creation preceded the modern disability rights movement, reflect a medical model of disability that is at odds with the social model. Analysing the Americans with Disabilities Act (which embodies the social model) and Social Security Disability Insurance (the largest welfare program for people with disabilities), we explore how and why this layering of contradictory disability rights and welfare programs developed and how it has been maintained. We argue that the tension between these policies engendered a series of patches, or ‘kludges’, that allow the policies to coexist without meaningful synthesis. We contend that the United States is particularly prone to this layering of ‘tense policies’, but that it is likely characteristic of disability policy in many nations. Finally we argue that accurate benchmarking of disability rights regimes across nations requires analysts to dig through all the layers of disability policy.

Disability retirement among university public servants: epidemiological profile and causes.

Abstract: Objective: To identify the epidemiological profile and causes of disability pensions for university public servants. Method: A cross-sectional and descriptive study, carried out with 40 retired employees due to disability of a public university. Sociodemographic, occupational and clinical data were obtained. The analyses were stratified according to gender, considering a significance level of 5%. Results: Disability pensions were more frequent among women (72.5%), aged up to 60 years (77.5%). Mental and behavioral disorders were mainly responsible for pensions (35%). There was a significant difference between the sexes (p ≤ 0.05) for the variables: educational level, function performed by the worker and presence of dependents. Conclusion: The epidemiological profile showed a higher frequency of female, married/stable marital status, aged between 51 and 60 years and up to 12 years of schooling. Chronic degenerative diseases were predominant among the causes for disability pensions.

The Intergenerational Transmission of Welfare Dependency

Abstract: There is a strong intergenerational correlation in welfare participation, but this does not imply that parental welfare receipt induces child receipt. While there are a few quasi-experimental studies that provide estimates of the causal effect of parental welfare participation for children from marginal welfare participants, we know very little about intergenerational spillovers of welfare participation onto the children of average welfare participants. By combining rich administrative data from Norway with weak mean-monotonicity assumptions, we estimate nonparametric bounds around the average causal effect of parental welfare participation on children’s welfare participation in the general population, as well as the average causal effect for children growing up in welfare-dependent families. We find that these average causal effects are considerably lower than the intergenerational correlation in welfare participation, and substantially below available local average treatment effect estimates in the literatu . We further find important differences between intergenerational spillovers of disability insurance and intergenerational spillovers of financial assistance, a traditional means-tested welfare program.

Return-to-Work Policies and Labor Supply in Disability Insurance Programs

Abstract: Return-to-work policies in disability insurance (DI) programs allow beneficiaries to collect a portion of their benefits while working. I investigate whether a large increase in incentives to work in a return-to-work policy could induce benefit recipients to increase their labor supply. I quantify the effects on earnings and labor force participation using a sharp discontinuity in the induced incentives to work at the month of the policy change in a DI program in Canada. Using administrative data, I document that large incentives to work could induce beneficiaries to increase their labor supply both in intensive and extensive margins.

Health, Labour, and the Environment: A Social Economic Analysis

Abstract: In this dissertation, I explore several social economic topics, including health, labour, and the environment. Although the chapters of this dissertation explore diverse subjects, the overall theme is to analyze important social issues and their policy implications. I made use of a variety of rich datasets, as well as employing various econometric analyses, often supported by a theoretical model, to examine the research topics identified in each chapter. In Chapter 1, I explore a 1997 policy change, which altered eligibility requirements for Disability Insurance (DI). While DI in Canada provides income support to millions, it has also been criticized for creating a disincentive for labour force participation. The 1997 change affected some Canadians, but not others, creating a natural experiment setting in which to explore this policy. I found that, following the tightening of eligibility requirements, relative labour force participation for women did increase, but their level of employment did not. There was little effect for men. This distinction between labour force participation and employment is a crucial one in this context: it indicates that what may appear to be individuals returning to work after not being eligible for DI may instead be individuals returning to the labour force, but unable to find suitable employment. In Chapter 2, I examine whether searching for health information on the internet acts as a complement or substitute for the demand for information from physicians (proxied by physician visits). I found that the effect on physician-based information hinged on an individuals prior trust in the formal medical sector: those with high prior trust tended to use health information searching on the internet as a complement for physician visits, whereas, those with low prior trust substituted away from physician visits in favour of information found online. The results were very similar when a telehealth program was examined instead of internet-based information. Further, those who were online health information searchers also tended to be more likely to use a telehealth program. This is a reassuring result, as it may mean that those who substituted out of the formal medical sector, in favour of health online information, may also be using the more quality-controlled telehealth programs. In Chapter 3, I explore how attitudes towards the environment affect behaviours in five key areas of environmental-related household consumption: waste generation and recycling, energy use, organic food consumption, personal transport, and water use. Prior studies have not examined these areas together, often due to data restrictions, and not in the context of environmental attitudes. Using a modelling procedure that allows for the errors in these five areas to be correlated, I found that attitudes were often a more significant predictor of ones behaviour than the financially driven policy implemented in the area.

Pathways Taken by New Social Security Disability Insurance and Supplemental Security Income Awardees

Abstract: We use administrative data to examine the various milestones achieved and pathways followed by new Social Security Disability Insurance (DI) and Supplemental Security Income (SSI) awardees. Our fin...

Social Security and Disability Due to Mental Impairment in Adults.

Abstract: The Social Security Administration (SSA) oversees two disability programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Adults with mental impairments represent a very large component of the programs. Policy makers and SSA are concerned about the accuracy of disability determination and also about low levels of labor force participation among individuals with disabilities. Adults with mental impairments are challenging to assess for work-related functional limitations. They are also a challenge to return to labor force participation. SSA has sponsored several demonstration research programs focusing on improving the accuracy of disability determination and on interventions in supported employment to return individuals with mental impairments to competitive employment. This article reviews the demonstration research focused on both entry into the disability system (at the "front door") and potential exit from it (through the "back door"). All of the research holds promise to "right-size" the SSA disability program.

The Health of Disability Insurance Enrollees: An International Comparison

Abstract: Rising costs of disability insurance (DI) programs are putting increased strain on central government budgets, yet little is known about how well countries target those in the poorest health. In this paper, we use the SHARE and HRS surveys to measure the average health of people aged 50-64 receiving DI, and the effectiveness of the DI safety net in covering those in poor health. The U.S. and Denmark appear successful at targeting benefits, with France and Belgium less so. These measures can also be used over time to evaluate country-level policy changes.

Mortality effects of containing moral hazard: Evidence from disability insurance reform.

Abstract: ____ We exploit an age discontinuity in a Dutch disability insurance (DI) reform to identify the health impact of stricter eligibility criteria and reduced generosity. Women subject to the more stringent rule experience greater rates of hospitalization and mortality. A €1,000 reduction in annual benefits leads to a rise of 4.2 percentage points in the probability of being hospitalized and a 2.6 percentage point higher probability of death more than 10 years after the reform. There are no effects on the hospitalization of men subject to stricter rules but their mortality rate is reduced by 1.2 percentage points. The negative health effect on females is restricted to women with low pre-disability earnings. We hypothesize that the gender difference in the effect is due to the reform tightening eligibility particularly with respect to mental health conditions, which are more prevalent among female DI claimants. A simple back-of-the-envelope calculation shows that every dollar reduction in DI is almost completely offset by additional health care costs. This implies that policy makers considering a DI reform should carefully balance the welfare gains from reduced moral hazard against losses not only from less coverage of income risks but also from deteriorated health.

The National Disability Insurance Scheme (NDIS) and mental health: A policy analysis

Abstract: The National Disability Insurance Scheme (NDIS) is a landmark policy commitment made by the Australian Government in 2013. The NDIS has established market mechanisms to support the delivery of services that, according to the National Disability Insurance Agency, offer participants both choice and control. The NDIS is also remarkable as being the first disability policy that has included mental health (referred to as psychosocial disability). There is a large financial commitment to delivering the NDIS, with a projected $22 billion investment by 2020 when full national roll-out is achieved; it is therefore necessary to analyse if the policy is effective in delivering the outcomes it promises. The aetiology of impairment in mental health conditions is largely positioned within the social, economic, systemic and political environments, the primary impact of which can be observed as stigma. This aetiology of impairment necessitates that policy promising to offer a better life to people living with mental health conditions, must have ecological frameworks central to policy mechanisms. It is imperative to understand what the NDIS policy foundations are to analyse if it is a viable alternative to current service delivery for people living with mental health conditions. A policy analysis is presented in two parts; firstly, a discourse analysis is undertaken that provides an historical context to the problem and further identifies the theoretical assumptions embedded in the policy foundations. Secondly, an analysis of the effectiveness of the NDIS in achieving its desired outcomes for psychosocial disability is measured against economic and social criteria. It is identified that the NDIS is a policy founded on strong neoliberal ideologies and whilst an ecological perspective is occasionally cited within policy material it is not supported within a market driven service delivery model. Due to the NDIS rollout being in its infancy there is a dearth of research around its effectiveness, this policy analysis identifies that there is a critical need for such research. Future research must specifically focus on outcomes for people with mental health conditions to advise on the need for ecological frameworks as an economically efficient and socially inclusive alternative.