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Disability policies and public views on work disability...

percent of the American population would shift their disability reporting from mild to
none if the U.S. adopted the German disability coverage policy.
The second graph presents the simulation results for the policy dimension of
disability levels for full benefits. In general, lower disability threshold for full benefits
seems to be associated with greater likelihood of reporting work disability and the
effect is concentrated in the mild disability category. However, the overall effect is only
moderate, which is consistent with what the OECD (2003) finds: although different
levels of work incapacity are required for full benefits, the proportions of people
receiving full benefits are very similar across countries. It suggests that the specified
incapacity levels are just a reference point for people to evaluate the relatively severe
work limitations, and the variations in the specific incapacity levels between countries
do not seem to matter much.
The third graph shows that changing the maximum disability benefit level would
mainly affect the rate of reporting mild and moderate/severe work limitations. On
average, a one-point increase in the generosity of maximum disability benefit level
is associated with 1 to 2.5 percentage point drop in self-reported mild disability, and
about 2 percentage point upswing in the rate of reporting moderate or severe disability.
The overall impact seems to be only modest of changing the maximum disability
benefit level on the way people rate work limitations.
In the fourth graph, we find that more permanent benefits shift the distribution of the
self-assessed disability severity towards the more severe end. The most distinct change
appears in the proportion of the population reporting no disability, which reduces by
2 to 3 percentage points for a one-unit increase in the generosity score for the more
permanent benefits. Apparently, the permanence of the benefits has only limited effects
on disability reporting.
In the fifth graph, we observe that more lenient medical assessment is associated with
higher rate of reporting moderate and severe work disabilities, but it is also associated
with higher rate of reporting no work disability and much lower rate of reporting mild
work disability. A medical assessment is considered more lenient if the process places
more weight on the treating doctor’s opinion and less likely involves insurance doctor.
Every one-unit increase in the generosity score of the medical assessment would lead
to a 1.3- to 2.5- percentage point increase in reporting moderate or severe disability,
and at the same time a 3.5- to 5-percentage point increase in reporting no disability.
This is interesting and may reflect heterogeneous effects in the population: On the one
hand, generous medical assessments in the country’s public disability evaluation may
make some people more likely to classify a given health problem as work limiting; on
the other hand, the more relaxed medical assessment in the disability system may be
viewed as excessive by others, making them reluctant to rate a given health problem as
disabling.
In the sixth graph, more relaxed vocational assessment is associated with more
reporting of moderate and severe disabilities and less reporting of no disability. A
one-unit increase in the generosity score of vocational assessment would raise the
proportion reporting moderate disabilities by 4.5 to 7.8 percentage points and the
proportion reporting severe disabilities by 1 to 2 percentage points, and reduce the rate
of reporting no disability by 4.3 to 5.7 percentage points.
A vocational assessment is considered stricter if all the available jobs in the national
economy, not only one’s own previous occupation, are considered in evaluating a
disability applicant’s residual work capacity. The vocational assessment in the U.S.
is strict: to qualify for the federal disability benefits, an applicant has to be deemed
unable to do any jobs available in the national economy. In other words, only
individuals who do not have residual work capacity would qualify for benefits. In most
European countries, the disability system uses one’s previous earnings or occupations
as reference when determining the individual’s eligibility for benefits, especially for
partial benefits.
In the simulation, we relax the strict U.S. vocational standard to allow the applicants
to engage in a different type of work (likely less demanding) than their previous

58 International Journal of Population Studies 2017, Volume 3, Issue 1