Up until 1990, the Netherlands experienced a considerable rise in the number of disability benefit recipients. In 1990, about 140 persons per 1,000 insured employees were in receipt of a disability benefit. This benefit was awarded after eligibility had been assessed following 52 consecutive weeks of incapacity to work (absence due to sickness). The beneficiary did not have to claim the benefit, rather, the administration carried out the assessment when sickness benefit payment had (almost) been exhausted. The disability benefit was effectively permanent in nature (paid until retirement age, 65 years) and covered both sickness and occupational injuries (as causes of disability). Some other main features of the disability programme at that time were:
1. the programme covered seven categories (degrees) of disability; about 80% of all recipients were in the highest category ("fully disabled");
2. the administration of the programme (public bodies governed by representatives of employers' associations and trade unions) did not carry out regular assessments. There was awareness that the scheme was being "used" as early retirement for older workers with less than good health;
3. like other income-replacement schemes (sickness, unemployment, social assistance), the administration and supervisory agencies mainly focused on the compensation function of the scheme. Until a few years ago, instruments and provisions for the retention or return to work of (partially) disabled persons had a relatively low priority in social policy.
From early 1990 onwards, various reforms were carried out in the sickness and disability system. In the disability scheme, benefit levels were reduced, eligibility criteria tightened, regular re-assessment introduced, and the cohorts of younger recipients re-examined in the light of the new criteria.
7.3.1.1. Reforms in return-to-work policy
After the introduction of reforms in the benefit schemes and their administration, improvements are now being prepared for the organisation and operation of programmes for reintegration (consisting of: assessment of remaining earning/vocational capacity, vocational rehabilitation, training and education, jobsearch, sheltered employment, etc.). In the spring of 1998, the "Act on Reintegration" (REA Act) was accepted by parliament. It aims to "solve" the present problems in the area of rehabilitation and return-to-work policies. Major problem areas are:
1. the prevailing rules and guidelines for reintegration measures and provisions are very detailed (e.g. regarding eligibility) and not consistent (e.g. regarding unemployed and disabled persons); there is a lack of flexibility, too much standardisation rather than "custom-made" measures; the present procedures require a lot of paper work and red tape (for clients, providers, employers);
2. clients, employers and administrators are not familiar with available measures; this has led to a considerable under-utilisation of the present repertoire of measures and provisions;
3. a lack of competition between providers of vocational rehabilitation and jobsearch and placement services;
4. monitoring and supervision of these activities is insufficient.
The new act provides a complex plan for "streamlining" the vocational rehabilitation and employment programmes, leading to more flexibility in eligibility criteria for provisions, better coordination of the organisations involved, etc. It also establishes the basis for an experiment with a "voucher" or "ticket", which gives the client more power and responsibility for acquiring services to improve his or her position on the labour market.
7.3.1.2. An experiment with a person-specific reintegration budget
The law supports the basic idea of giving the client more responsibility and influence regarding return-to-work measures ("empowerment"). Thus, an experiment with a voucher programme has been proposed, which takes some features from similar plans such as the Berkowitz "ticket" for disabled persons (USA) and the Snowers plans regarding vouchers for the unemployed (UK). Agencies presently providing vocational rehabilitation and re-employment under the pilot scheme have "mixed feelings" about the feasibility and impact, whereas client organisations favour this new approach. However, all these actors are willing to commit themselves to a pilot project to find out whether a voucher approach works better than the present procedures and measures.
Last year the AS/tri Research & Consultancy Group provided the government with additional information on the U.S. plans. These ideas were discussed in a report from a cross-national study of selected vocational rehabilitation measures1. Now AS/tri has been commissioned to monitor the elaboration and implementation of the "Person-specific Reintegration Budget" programme in three regions and to prepare the evaluation of this programme.
7.3.1.3. Initial features of programme and experiment
We now present some main features of the plan, as formulated by the government. These are to be elaborated in three regional pilot projects. It should be noted that the following information does not reflect the "final" version of the programme or experiment. Present plans still are subject to further discussions and adaptations.
- improve clients' work capacity and increase their (re-)integration into gainful employment;
- improve flexibility and efficiency in the operation of vocational rehabilitation and employment measures.
Clients:
- persons not working and receiving partial disability benefit, unemployed persons with health constraints, persons on social assistance with health constraints;
- participation in the experimental programme should be on a voluntary basis;
- clients should be willing to be interviewed for the evaluation study.
Person-specific budget:
- two formats will be available: a standard budget of NLG 10,000 for a maximum of one year, and a flexible "custom-built" budget of NLG 50,000 when services are needed over an extended period;
- in the case of the flexible budget, the client has to send in a personal reintegration plan for acceptance by the agency that provides the benefits;
- the budget can be used by the client to "buy" training, consultancy or placement services.
Experiment:
- pilot projects are envisaged for three different regions, each aiming at up to 150 clients in the experimental group;
- for assessing the impact on the two experimental groups (i.e. standard budget, flexible/custom-built budget), a control group will be selected;
- administrative circumstances (available research and registration conditions in the regions) will largely determine the design of the experiment and measuring, etc.;
- evaluation of the programme should be completed after a maximum of four years.
7.3.1.4. Outlook
The preparations for the programme and its implementation in three regions started in June 1998. Many aspects still have to be elaborated, regions are being recruited, administrations have to make preparations, and researchers are elaborating an analytical frame of reference, preparing interview protocols (case managers, process information experts), etc.
The research team involved in this project will be pleased to provide further information within the conditions of the assignment. We would also be pleased to receive information about similar programmes (vouchers, personal budgets) aiming at return to work as well as other evaluation projects in this area.
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