Why have disability categories in social security?
Deborah Mabbett
Brunel University
Uxbridge UB8 3PH
email: deborah.mabbett@brunel.ac.uk
Abstract
The specification of categories (unemployment, old age, disability, etc) is a well-established
feature of social security. However, disability categories are problematic: the evidence on which
decisions have to be made is complex, and understandings of the nature of disability are highly
contested. Disability categories could be reformed by unification with other categories used in
the same policy area (e.g. unemployment) or by fragmentation into new, smaller categories,
particularly through the use of casework.
1
Why have disability categories in social security?
The administration of social security involves drawing boundaries to determine who is entitled
to benefits and who is not. The specification of categories (unemployment, old age, disability,
etc) in legislation may help to promote justice in this process. However, the categories are often
problematic, particularly the disability categories. The evidence on which decisions have to be
made is complex and susceptible to different interpretations, and understandings of the nature of
disability are highly contested.
Recent years have seen the emergence of a disability rights movement which has succeeded in
changing the way disability is understood in social policy. The social model of disability
emphasises that impairments do not have to be disabling: disabling effects arise from social
structures which discriminate against and exclude those with impairments. The model therefore
draws a clear distinction between impairment and disadvantage. One implication for social
security categorisation might be as follows. If social security is concerned with addressing
disadvantage, it may not necessarily always be relevant to consider impairment; furthermore,
disadvantaged people with impairments may have a lot in common with people who have
similar disadvantages but are not impaired. This suggests that social security disability
categories, which select for different treatment people with impairments who also have certain
disadvantages (low income, no job, constrained mobility, care needs, etc), might be dispensed
with in favour of categories based on disadvantage alone.
Disability categories could be done away with in two ways: by being combined with other
categories used in the same policy area (e.g. for income maintenance, with the unemployed (or
2
‘jobseeker’) and lone parent categories) or by being re-divided into new, smaller, more refined
categories. Indeed, if we recognise that categorisation is done at different levels: in legislation,
development of managerial procedures, and administrative encounters, we can see that reform
of categories may entail a combination of categorical unification (at the legislative policy level)
and fragmentation (at the level of the administrator-client relationship).
Unification of categories is implied by schemes for negative income taxes or basic incomes.
Supporters of these schemes argue that established categories are designed around patterns of
working life which have changed, and that larger categories, with no distinctions between those
who are expected to be working and those who are not, can be the basis of a more flexible
system. Fragmentation of categories is reflected in the adoption of ‘casework’ methods, in
which the benefits awarded to applicants and the services provided are tailored to their
individual needs and circumstances. For example, a contract may specify the client’s obligations
to seek work, attend training sessions etc; these individually-negotiated arrangements replace
the general categorical obligation on unemployed people to make themselves available for work
and to look for work.
It is helpful to start with an idea of the different situations in which disability categories are
used, in order to predict the issues that might be raised by unification or fragmentation. The
following discussion uses information gathered in a research project conducted for the European
Commission, which looked at how people were assigned to disability categories in the
administration of social security, employment services and care provisions across the European
states (Mabbett, 2003a). The very structure of the research project indicates the ubiquity of
disability categories, but the situations in which the categories were used varied widely.
3
Disability and employment
All the income maintenance systems of the EU member states have an ‘incapacity’ or
‘invalidity’ category. The first condition of eligibility for this category is lack of income from
work. A range of alternative classifications is available for people without an income from
work: unemployed, early retired, partially or fully incapacitated, etc. The way these different
categories are defined and structured depends partly on institutional legacies (e.g. the existence
of different insurance institutions for different ‘risks’) and partly on the country’s employment
policy. Changes in policy towards the unemployed have implications for the definition of
incapacity. In a number of countries, including the UK, supply-side interpretations of
unemployment, emphasising the lack of work readiness of unemployed people, now dominate
over demand-side interpretations (emphasising the lack of jobs). This has led to the
development of new policies to assist people to enter employment, with a new set of analytical
tools and administrative practices. The analytical tools include ideas about multiple and interrelated barriers to employment, which may be social, environmental and personal.
The
administrative practices include the increased use of casework.
These changes in the conduct of policy towards the unemployed have several implications for
disability policies. Distinctions between disabled people and other jobseekers may become less
important in the delivery of employment services such as placement assistance and training.
This might then have knock-on effects on the administration of income maintenance benefits. In
the UK, the ‘Jobcentre Plus’ initiative reflects the idea that access to mainstream employment
services may enable groups who are not required to look for work (lone parents and carers as
well as disabled people) to enter employment. So far, there have been no knock-on effects on
4
categorisation for benefits, but some consequences might be expected in the future, if only
because of the inconsistency between classifying people as incapable of work and requiring
them to attend a work-focused interview.
In a number of European countries, the role of disability categories in employment service
provision has been reduced. Services for disabled people have been brought under the same
institutional structure as those for other job-seekers and the package of services offered has been
made more similar to the general package. In some of these institutions, not much rests on
giving a person a disability classification, and not all people who might qualify seek to be
labelled as disabled. While many commentators see this ‘mainstreaming’ of employment
services as a positive development, there is concern that specialised provision which recognises
the particular problems and barriers facing disabled people is not being made available.
In the main, income maintenance benefit systems do still use disability categories defined
around ability to work, but there are some exceptions. Reforms currently in progress in
Denmark will remove work incapacity categories from the income maintenance system,
eliminating the categorical distinction between disabled people and other working age recipients
of benefits delivered via the municipalities (unemployment insurance is delivered by insurance
institutions). This is the culmination of a long-running set of ‘activation’ reforms which have
greatly expanded the legal and financial scope for the exercise of local discretion to promote
employment. This casework-based system is seen as having the flexibility to respond to the
individual needs and circumstances of clients.
In France there has been a debate about the use of the disability category in income maintenance
5
policy which focuses on the relationship between the means-tested disability benefit (AAH) and
the general social assistance benefit, RMI. RMI recipients are meant to have contracts of
‘insertion’ which will promote an eventual return to the labour market, whereas AAH does not
have any insertion requirements. Surveys of RMI recipients suggest that about one-third have
some limiting health condition, and presumably this is sometimes reflected in the terms of the
insertion contract (e.g. limitations on availability for work as a result of poor health may be
accepted). It is arguable that, if the contracts are sufficiently flexible, it should not be necessary
to have a separate disability benefit, as the administration of the general benefit can respond to
the needs of disabled people. However, the establishment of individual contracts for Rmistes has
proved administratively burdensome, and perhaps AAH survives partly because of this.
The comparison of the Danish and French examples suggests that the capacity of the system to
undertake effective casework is a key issue in the unification of categories. The Danish system
is decentralised and is built on a long tradition of linking social work to social assistance. Our
research suggests that centralised social security systems may not have the mechanisms of local
governance necessary to support the discretionary, individually-based approach adopted in
Denmark. The UK’s system is highly centralised, and this is likely to be an important constraint
on reforms to the structure of social security categories.
Disability and old age
Particular issues affect the determination of disability among older workers. For example, some
countries have early retirement provisions which require that a limiting health condition is
present, without imposing the stringent medical conditions of the main disability assessment.
Other countries have allowed older workers onto disability benefits in preference to classifying
6
them as unemployed. These systems are now faced with the policy problem of reducing early
retirement and raising the effective retirement age. One way to do this is to tighten up on the
medical criteria for getting a disability classification and so being exempted from the
requirement to seek paid work The OECD (2003) has found that, in general, states which
impose rigorous medical conditions for receipt of disability benefits appear to make fewer
awards. One indicator of strong medical scrutiny is that the institution undertakes its own
medical investigations and employs its own doctors, instead of relying on outside medical
reports. Another indicator concerns the scope of the medical investigation: whereas in the UK
the medical report is limited to determining a person's functional capacity, some continental
institutions investigate the medical diagnosis and review the programme of medical treatment.
(In several countries, a single insurer finances health care services and sickness and disability
cash benefit provision, so the ‘treating doctor’ and the ‘benefits doctor’ are working for the
same institution.)
However, it only makes sense to tighten up the medical adjudication of disability if one is
convinced that the medical criteria are meaningful. Restrictive medical requirements can lead to
institutions making distinctions between people with similar needs that are hard to justify. For
example, older workers may have minor limiting health conditions compounded by restricted
opportunities to change their area of work. This may mean that the administrative practices
associated with the unemployment category are not suitable, while at the same time the medical
requirements for disability benefits are not met. Social security systems might respond better to
the needs of this group if they adopted a unified ‘flexible retirement’ category in which medical
criteria were not central, rather than seeking to establish clear borderlines between disability,
unemployment and old age (Mabbett, 2003b).
7
Disability and care and mobility needs
Income maintenance is the main area in which disability categories are used in social security,
but in recent years another area has grown in importance, which arises when categories are used
to allocate extra resources to people whose cost of living is increased by difficulties in looking
after themselves, mobility limitations, or other extra costs such as special diets.
The evolution of social security categories does not always display tidy connections between
category definitions and purposes. One result is that disability categories have been used both to
resolve work participation issues and award extra benefits for extra costs, without much
consideration of whether work incapacity and extra costs really go hand-in-hand. However,
some countries are separating these aspects of disability, particularly with a view to promoting
employment among people who have significant extra costs but are able to work. In the UK,
Disability Living Allowance (DLA) is separately assessed, and may be paid to people who are
working. Eligibility for DLA is assessed by looking at a person’s ability to perform various
activities of daily life (ADLs), whereas eligibility for income maintenance benefits looks at a
person’s ability to perform activities supposedly connected with employment.
To what extent have other countries also constructed new disability categories around the
performance of ADLs? This simple question turns out to have a complex answer. ADL
assessments are widely used across Europe for the delivery of care services, but they are often
used to create fragmented and informal categories. The assessor may consider only the client’s
suitability for a particular intervention, or he or she may work out a unique care package for the
recipient. Nonetheless, there are trends towards the development of higher-level categories as
8
service delivery is cashed out and care managers are called on to determine budget bands or
limits for service recipients.
These higher-level categories are not necessarily understood to be ‘disability’ categories,
however. One important issue is that care provision is often dominated by elderly people,
whereas work-oriented social security disability categories are confined to the working age
population (at least at the commencement of the claim). This means that the category created by
ADL assessments may be considerably more encompassing, or unified, than the established
social security category. It also need not be understood as a ‘disability’ category; other terms
like ‘dependence’ or ‘in need of care’ may be used instead. For example, the introduction of
care insurance in Germany and Austria has seen the establishment of ‘care’ categories which
encompass the elderly as well as younger people and are not primarily seen as disability
categories. The basis for making a categorical distinction within the ‘care’ group between aging
and disability is not self-evident. Some states simply operate age limits (including the UK);
others try to draw a distinction between ‘normal’ aging and disability based on medical criteria.
Disability and impairment
In the provisions discussed so far, impairment does not in itself bring forth a social policy
response; instead, disability categories are derived by linking situations of disadvantage (lack of
work, care needs) to medical evidence of impairment. However, there are some disability
categories in Europe in which evidence of impairment is itself sufficient to determine a
disability rating; i.e. to categorise a person as disabled. In practice there are some problems
assessing a person’s degree of disability directly from a description of the medical condition;
implicitly or explicitly a judgment about the severity of a condition is likely to consider its
9
consequences for important life activities. However, it is still possible to identify some
assessment systems in which impairment is what ‘counts’.
Disability ratings derived by assessing impairment are widely used in employment quota
systems. Travel concessions and parking permits may also be allocated on this basis. In some
states, means-tested benefits are paid on better terms to those with disability ratings than to
those without.
There are a number of possible rationales for these systems, all of which involve some
extension of or deviation from the idea that social policy is concerned with combating
disadvantage. Impairment-based employment quotas might be rationalised as promoting
equality of opportunity, although it is arguable that they have more to do with shifting the cost
of income maintenance from the state to employers. Benefits and privileges for people with
impairments can be understood as gestures towards compensation for harms inflicted by society
(e.g. war injuries) or sheer bad luck.
The use of these disability categories therefore gives some insight into how the aims of social
policy are defined in different countries. In states where compensation is largely privatised, we
may find impairment-based assessments used by insurance companies and courts in settling
negligence and other damages claims. By contrast, in countries where state or social insurance
institutions are charged with providing compensation, impairment-based assessments may be
part of the social security system.
Conclusion
10
Part of answering the question: ‘why have disability categories in social security’ is to explain
the reasons for having categories at all. One answer is that the specification in law of major
categories of benefit recipient reduces the role of the more fragmented low-level categorisation
which accompanies casework. Casework can be burdensome and expensive, and it places high
levels of discretionary power at the street level. Legislated categories are, therefore, very useful,
provided that administrators can identify who belongs to them and that they make distinctions
which are relevant to the purposes of the policy and are seen as legitimate.
The major categories have included disability for a long time, yet the precise reasons for having
disability categories for each specific service or benefit are complex and variable. Given the
importance and difficulty of categorisation, governments approach the task of defining new
categories and redefining existing ones with justifiable caution. Yet governments’ responses to
rising numbers in disability categories often suggest that they are trapped in an ‘essentialist’
view of disability which serves social policy poorly. The essentialist view is that there is a core
of ‘truly’ disabled people which is diluted with marginal cases. When numbers rise, the
response is to tighten the boundaries to select only the core and exclude the others. This is done
by sharpening the medical conditionality attached to the category.
An alternative response is to recognise that disability categories are constructed (or were
constructed, some years ago) for particular social policy purposes. The primary issue is,
therefore, to establish what each category is for. For example, if the aim is to determine what
participation conditions should be placed on an income maintenance recipient, it may be
appropriate to develop new categories for new labour market conditions, and it may not be
necessary to draw distinctions between disabled people and others with similar disadvantages.
11
References
Mabbett, D. (2003a) Definitions of Disability in Europe: A Comparative Analysis, European
Commission, Employment and Social Affairs Directorate-General, forthcoming. (A draft
version is available from: http://www.brunel.ac.uk/depts/govn/research/disability.htm.)
Mabbett, D. (2003b) ‘Transforming Disability into Ability: A Commentary Based on Recent
European Research’ Transforming Disability into Ability Dissemination Conference, Vienna 67 March. (Available from http://www.euro.centre.org/ability/summaries.pdf, pp.23-30)
OECD (2003) Transforming Disability into Ability: Policies to Promote Work and Income
Security for Disabled People, Paris: OECD.
12