International Tax and Public Finance

, Volume 18, Issue 2, pp 146–165 | Cite as

Health, disability and work: patterns for the working age population

  • Pilar García-Gómez
  • Hans-Martin von Gaudecker
  • Maarten Lindeboom
Open Access


We examine the role of health as a determinant of labour force participation, paying particular attention to the link between the two provided by disability insurance schemes. We first review the evidence on associations between health and labour force participation. Enrolment in disability insurance is not determined by health alone, and we highlight the main other causes that the literature has identified. In an application to The Netherlands, we follow the structure of the literature review and show that the trends in health and disability insurance enrolment look rather positive. In particular, the 1990 reforms of disability insurance might have been more effective than previously realised because part of their success was hidden by demographic change: The large number of baby boomers kept the absolute inflow high as they aged, despite large reductions in relative rates.


Health Disability Disability insurance Labour force participation 

JEL Classification

J2 I1 J08 


  1. Autor, D. H., & Duggan, M. G. (2003). The rise in the disability rolls and the decline in unemployment. Quarterly Journal of Economics, 118(1), 157. CrossRefGoogle Scholar
  2. Autor, D. H., & Duggan, M. G. (2006). The growth in the social security disability rolls: A fiscal crisis unfolding. Journal of Economic Perspectives, 20(3), 71–96. CrossRefGoogle Scholar
  3. Banks, J., Emmerson, C., & Tetlow, G. (2007). Healthy retirement or unhealthy inactivity: How important are financial incentives in explaining retirement? (Mimeo). Institute for Fiscal Studies, London. Google Scholar
  4. Berthoud, R. (2008). Disability employment penalties in Britain. Work, Employment & Society, 22(1), 129–148. CrossRefGoogle Scholar
  5. Besseling, J., Hagen, B., Andriessen, S., te Peele, A., Crone, M., Kok, L., & de Vos, E. (2007). Toename gebruik ondersteuning voor jongeren met een gezondheidsbeperking (tNO Rapport No. 385), available
  6. Bhattacharya, J., Choudhry, K., & Lakdawalla, D. N. (2008). Chronic disease and severe disability among working-age populations. Medical Care, 46(1), 92–100. CrossRefGoogle Scholar
  7. Black, D., Daniel, K., & Sanders, S. (2002). The impact of economic conditions on participation in disability programs: Evidence from the coal boom and bust. American Economic Review, 92(1), 27–50. CrossRefGoogle Scholar
  8. Blundell, R. W., & Preston, I. (1998). Consumption inequality and income uncertainty. Quarterly Journal of Economics, 113(2), 603–640. CrossRefGoogle Scholar
  9. Blundell, R. W., Pistaferri, L., & Preston, I. (2008). Consumption inequality and partial insurance. American Economic Review, 98(5), 1887–1921. CrossRefGoogle Scholar
  10. Bound, J., & Burkhauser, R. V. (1999). Economic analysis of transfer programs targeted on people with disabilities. In O. C. Ashenfelter & D. Card (Eds.), Handbook of labor economics (Vol. 3, pp. 3417–3528). Amsterdam: Elsevier, Chap. 51. Google Scholar
  11. Bound, J., & Waidmann, T. (2002). Accounting for recent declines in employment rates among working-aged men and women with disabilities. The Journal of Human Resources, 37(2), 231–250. CrossRefGoogle Scholar
  12. Case, A., & Paxson, C. (2005). Sex differences in morbidity and mortality. Demography, 42(2), 189–214. CrossRefGoogle Scholar
  13. Crimmins, E. M., Reynolds, S. L., & Saito, Y. (1999). Trends in health and ability to work among the older working-age population. Journal of Gerontology, Series B, 54(1), S31–S40. Google Scholar
  14. Cunha, F., & Heckman, J. J. (2007). The technology of skill formation. American Economic Review, 97(2), 31–47. CrossRefGoogle Scholar
  15. Cunha, F., & Heckman, J. J. (2008). Formulating, identifying and estimating the technology of cognitive and noncognitive skill formation. Journal of Human Resources, 43(4), 738–782. Google Scholar
  16. Cunha, F., Heckman, J. J., Lochner, L., & Masterov, D. V. (2006). Interpreting the evidence on life cycle skill formation. In E. Hanushek & F. Welch (Eds.), Handbook of the economics of education (Vol. 1, pp. 697–812). Amsterdam: Elsevier. CrossRefGoogle Scholar
  17. Currie, J., & Madrian, B. C. (1999). Health, health insurance and the labor market. In O. C. Ashenfelter & D. Card (Eds.), Handbook of labor economics (Vol. 3, pp. 3309–3416). Amsterdam: Elsevier, Part 3, Chap. 50. Google Scholar
  18. de Jong, P. (2008). Recent changes in Dutch disability policy (Mimeo). University of Amsterdam. Google Scholar
  19. de Jong, P., & Thio, V. (2002). Donner versus Veldkamp: over nut en nadeel van gedeeltelijke wao-uitkeringen (aPE-report 53). Google Scholar
  20. de Jong, P., Thio, V., & Barteling, H. (2005). Uwv als poortwachter (aPE report 127). Google Scholar
  21. de Jong, P., Lindeboom, M., & van der Klaauw, B. (forthcoming). Screening disability insurance applications. Journal of the European Economic Association. Google Scholar
  22. Duggan, M., & Imberman, S. (2006). Why are the disability rolls skyrocketing? The contribution of population characteristics, program changes and economic conditions. In D. Cutler & D. A. Wise (Eds.), Health in older ages: The causes and consequences of declining disability among the elderly. Chicago: University of Chicago Press. Google Scholar
  23. García-Gómez, P. (2008). Institutions, health shocks and labour outcomes across Europe (Documento de Trabajo 2008-01 FEDEA). Google Scholar
  24. García-Gómez, P., & López Nicolás, A. (2006). Health shocks, employment and income in the Spanish labour market. Health Economics, 15, 997–100. CrossRefGoogle Scholar
  25. Guiso, L., Pistaferri, L., & Schivardi, F. (2005). Insurance within the firm. Journal of Political Economy, 113(5), 1054–1087. CrossRefGoogle Scholar
  26. Heckman, J. J. (2008). Schools, skills, and synapses. Economic Inquiry, 46(1), 1. CrossRefGoogle Scholar
  27. Heckman, J. J., & Masterov, D. V. (2007). The productivity argument for investing in young children. Review of Agricultural Economics, 29(3), 446–493. CrossRefGoogle Scholar
  28. HMD (2009). Human mortality database.
  29. Kapteyn, A., Smith, J. P., & van Soest, A. (2007). Vignettes and self-reports of work disability in the united states and the netherlands. American Economic Review, 97(1), 461–473. CrossRefGoogle Scholar
  30. Kerkhofs, M., Lindeboom, M., & Theeuwes, J. (1999). Retirement, financial incentives and health. Labour Economics, 6(2), 203–227. CrossRefGoogle Scholar
  31. Koning, P. W. C. (2009a). Experience rating and the inflow into disability insurance. De Economist, 157(3), 315–335. CrossRefGoogle Scholar
  32. Koning, P. W. C. (2009b). Herbezinning op onderkant arbeidsmarkt. Economisch Statistische Berichten, 94(4551), 24–25. Google Scholar
  33. Koning, P. W. C., & van Vuuren, D. J. (2010). Disability insurance and unemployment insurance as substitute pathways. Applied Economics, 42(5), 575–588. CrossRefGoogle Scholar
  34. Kreider, B., & Riphahn, R. T. (2000). Explaining applications to the U.S. disability system: A semiparametric approach. The Journal of Human Resources, 35(1), 82–115. CrossRefGoogle Scholar
  35. Lakdawalla, D. N., Bhattacharya, J., & Goldman, D. P. (2004). Are the young becoming more disabled? Health Affairs, 23(1), 168–176. CrossRefGoogle Scholar
  36. Lechner, M., & Vazquez-Alvarez, R. (2004). The effect of disability on labour market outcomes in Germany: Evidence from matching (cEPR Discussion Paper 4223). Google Scholar
  37. Lindeboom, M. (2006). Health and work for older workers. In A. M. Jones (Ed.), The Elgar companion to health economics (pp. 26–35). Cheltenham: Edward Elgar, Chap. 3. Google Scholar
  38. Lindeboom, M., Llena Nozal, A., & van der Klaauw, B. (2007). Health shocks, disability and work (Netspar Discussion Paper 11/2007-026). Google Scholar
  39. Low, H. W., & Pistaferri, L. (2010). Disability risk, disability insurance, and life-cycle behavior (nBER Working Paper 15962). Google Scholar
  40. Low, H. W., Meghir, C., & Pistaferri, L. (forthcoming). Wage risk and employment risk over the life cycle. American Economic Review. Google Scholar
  41. MaCurdy, T. E. (1982). The use of time series processes to model the error structure of earnings in a longitudinal data analysis. Journal of Econometrics, 18(1), 83–114. CrossRefGoogle Scholar
  42. McWhinnie, J. R., Törnudd, P., Ås, D., & Pelli, C. (1982). Measuring disability (5th ed.). OECD Social Indicator Development Programme, Special Studies, Paris: OECD. Google Scholar
  43. Meghir, C., & Pistaferri, L. (2004). Income variance dynamics and heterogeneity. Econometrica, 72(1), 1–32. CrossRefGoogle Scholar
  44. Møller Danø, A. (2005). Road injuries and long-run effects on income and employment. Health Economics, 14(9), 955–970. CrossRefGoogle Scholar
  45. OECD (2008). Sickness, disability and work: Breaking the barriers : Vol. 3. Denmark, Finland, Ireland and The Netherlands. Paris: OECD Publishing. Google Scholar
  46. OECD (2009). Employment outlook 2009: Tackling the jobs crisis. Paris: OECD Publishing. CrossRefGoogle Scholar
  47. Oeppen, J., & Vaupel, J. W. (2002). Broken limits to life expectancy. Science, 296(5570), 1029–1031. CrossRefGoogle Scholar
  48. Parsons, D. O. (1991). Self-screening in targeted public transfer programs. Journal of Political Economy, 99(4), 859. CrossRefGoogle Scholar
  49. Riphahn, R. T. (1999). Income and employment effects of health shocks a test case for the German welfare state. Journal of Population Economics, 12(3), 363–389. CrossRefGoogle Scholar
  50. Schweinhart, L. J., Barnes, H. V., & Weikart, D. P. (1993). Significant benefits: The high/scope Perry preschool study through age 27. Ypsilanti: High/Scope Press. Google Scholar
  51. Schweinhart, L. J., Barnett, W. S., & Belfield, C. R. (2005). Lifetime effects: The high/scope Perry preschool study through age 40. Ypsilanti: High/Scope Press. Google Scholar
  52. Stapleton, D. C., Coleman, K. A., Dietrich, K. A., & Livermore, G. A. (1998). Econometric analyses of DI and SSI application and award growth. In K. Rupp & D. C. Stapleton (Eds.), Growth in disability benefits explanations and policy implications. Kalamazoo: W. E. Upjohn Institute for Employment Research. Google Scholar
  53. Suijker, F. W. (2007). Verdubbeling van de instroom in de wajong: Oorzaken en beleidsopties. Netherlands Bureau for Economic Policy Analysis, CPB Document 156. Google Scholar
  54. Tweede Kamer der Staten-Generaal (2008). Wijziging van de wet arbeidsongeschiktheidsvoorziening jonggehandicapten in verband met het bevorderen van de participatie van jonggehandicapten door werk en arbeidsondersteuning (Memorie van Toelichting). Kamerstukken 31780, no. 3. Google Scholar
  55. Uitvoering Werknemersverzekeringen (2007). De groei van de wajonginstroom (Kenniscahier 07-01). Google Scholar
  56. Uitvoering Werknemersverzekeringen (2008). De participatiemogelijkheden van de wajonginstroom (Kenniscahier 08-01). Google Scholar
  57. van Kippersluis, H., O’Donnell, O., van Doorslaer, E., & van Ourti, T. (2010). Socioeconomic differences in health over the life cycle in an egalitarian country. Social Science & Medicine, 70(3), 428–438. CrossRefGoogle Scholar
  58. van Sonsbeek, J.-M., & Gradus, R. H. J. M. (2006). A microsimulation analysis of the 2006 regime change in the Dutch disability scheme. Economic Modelling, 23, 427–456. CrossRefGoogle Scholar

Copyright information

© The Author(s) 2010

Authors and Affiliations

  • Pilar García-Gómez
    • 1
    • 5
  • Hans-Martin von Gaudecker
    • 2
    • 5
  • Maarten Lindeboom
    • 3
    • 4
    • 5
  1. 1.Erasmus University RotterdamRotterdamThe Netherlands
  2. 2.Universitat MannheimMannheimGermany
  3. 3.VU University AmsterdamAmsterdamThe Netherlands
  4. 4.IZABonnGermany
  5. 5.NetsparTilburgThe Netherlands

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