Definitions from disability programmes in other countries

Social Security Advisory Board Washington DC 14 April 2004 Marilyn Howard

What this presentation covers
1. The context 2. Purposes of definitions 3. Social security definitions of disability 4. Administration and assessment 5. The British experience 6. Some possible alternatives

The context
• The concept of disability in society
– Influence of disability models – ‘dynamics’

• Rising numbers of disability benefit recipients • Role of social security
– Deserving – Can’t work – Poor

Purposes of definitions
• Definitions - different or related? • Anti-discrimination definitions
– Individual approaches – Environmental approaches

• Employment
– Narrower – For specialist programmes, targeted populations, quota – Separate definition from provision or common definition

Social security definitions
• Income maintenance
– – – – – – – Reduced capacity to work or earn Labour market considerations Absolute or relative Impairment and work capacity Work capacity including hours Permanence/years Partial benefits

• Extra costs
– Activities of Daily Living

• Compensation
– Impairment/Percentage rating

Examples
Australia Disability Support Pension 3. Score 20 points on impairment tables 4. Continuing inability to work more than 30 hours or more within two years Sweden Disability Insurance 25% work capacity reduction ‘Partial disability’ in 25% increments by hours

‘Partial’ benefits means in some countries people work and claim
Employed, no benefits
100

Employed, w ith benefits

Non-employed, no benefits

Non-employed, w ith benefits

90 80

70

60

50 40

30

20 10

0

• • • •

Administration as important as definitions Traditional medical/’absolutist’ view Disability as a category Institutional reforms in some countries
– Merging benefits and employment – Linking to sickness insurance

Administration & assessment

• Access and review • Assessment
– Snapshot or process – Medical or administrative

Assessment models in Europe
A. Low medical evidence, high discretion B. Low medical evidence, low discretion C. High medical evidence, high discretion D. High medical evidence, low discretion Professionals outside social security eg social workers, often local Doctors advise lay decision-makers Doctors decide, often health and benefits Structured ‘medical’ data eg impairment tables

The British experience (1)
• Disability Discrimination Act – individual approach • Incapacity benefit
– – – – Incapacity for all work (28 weeks) Functional assessment with exemptions ‘Active’ measures added Inflows reducing but means-tested equivalents rising – Pilot programme based on different model – Form/often medical examination

The British experience (2)
• Disability Living Allowance
– care component – attention/supervision – mobility component – unable to walk/exertion/’severe mental impairment’/guidance – Self-reporting/further evidence

• About half of IB/DLA appeals successful • Policy conflates sickness and

Some possible alternatives
• Streaming/profiling • Two stage assessments • Using the revised WHO definition • Single working age benefit • Extra costs instead of work capacity • Compensation for discrimination • No distinct category at all