Dutch politicians struggle with disability benefit

BMJ 1994; 308 doi: (Published 25 June 1994) Cite this as: BMJ 1994;308:1659
  1. R Pascoe

    One of the biggest questions facing the new Dutch government is what, if any, further measures to take to reduce the number of people claiming disability benefit. Three parties, the conservatives, labour, and the centrist party, have been locked in talks on forming a new coalition government since the general election on 3 May: the social security budget is proving to be one of the biggest stumbling blocks.

    According to the Social Insurance Council, at the end of 1993 one in 10 of the working population was claiming either full or partial disability benefit. The cost of the benefit seems to be falling thanks to changes in the criteria for eligibility and a reduction in the level of benefits, but the conservative party in particular wants to reduce the bill still further.

    In January a new system of calculating entitlement to disability benefit came into operation. Until then employees who became fully disabled were entitled to 70% of their last earned salary until reaching the age of 65. Now the length of this entitlement depends on age. All disabled workers have to undergo medical checks every five years to reassess the level of their disability. The social affairs ministry hopes that stricter medical checks will help to stop companies from using the system to get rid of older employees. In addition, claimants are now also obliged to accept any job that can be found for them.

    While these measures seem to have had an effect (the Social Insurance Council reports a drop of 10% in new claims so far this year), other measures are not proving so successful. The difference between the old 70% rate of entitlement and the new age dependent rate has been largely compensated for by compulsory top up insurance schemes for employees, which make up benefit to the old level and have been included in most collective labour agreements. Prime Minister Ruud Lubbers has attacked employers for agreeing to provide such top up policies, arguing that they undermine the cabinet's measures to cut the number of people claiming disability benefit.

    The introduction of the so called bonus/ malus system last year, whereby a company with an employee who ends up claiming disability benefit is fined and a company that takes on a disabled employee is given a financial reward, is also likely to be reviewed. Employees' organisations have attacked the scheme, arguing that it is unfair to fine a company if an employee becomes disabled through an incident that is not related to work, such as a sports accident. Indeed, companies are becoming more wary about employing people who have a history of bad health or who pursue dangerous hobbies.

    The bonus/malus system is likely to be scrapped by the next government, and political sources also suggest that the compulsory element of the top up insurance for disability benefit is likely to be removed. Instead employers could be obliged to offer such a policy in a collective labour agreement, but unwilling employees could not be forced to pay for it.

    A report leaked from the social security administrative office at the beginning of this month predicated that the number of disability claims would fall by 130 000 by 1997 and warned the incoming government not to take any hasty steps to reduce the bill still further. The social affairs ministry disputes this, arguing that the postwar baby boom will lead to an increase in claimants in their 40s and 50s over the next few years. Overall the ministry expects the number of claimants to remain stable until the turn of the century.

    But while the bill for disability benefit may decrease there could be a corresponding rise in claims for unemployment benefit, merely pushing the problem elsewhere.

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