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Activate the most vulnerable? The case of the Disability Insurance reveals many paradoxes

The three most recent reforms of DI in Switzerland have sought to stem rising costs by requiring insured persons to make greater efforts to rejoin the labour market. Emilie Rosenstein has examined this development from both a quantitative and a qualitative perspective, and highlights the ambivalence of the changes made: her thesis identifies several asymmetries between the stated objectives and the results obtained, as well as between the standards promoted and the actual effects they have on people with disabilities.

“Only those who use their freedom remain free and (...) the strength of a people is measured by the well-being of its weakest members.” This excerpt from the preamble of the Swiss Constitution completes Emilie Rosenstein's doctoral thesis on the contradictions of an important part of social policy in Switzerland, which, despite advocating integration of beneficiaries, actually leads to forms of exclusion.

This thesis in sociology, which was defended at the University of Geneva on 12 February 2018 and prepared under the supervision of Prof. Jean-Michel Bonvin, analyses the recent developments in Disability Insurance (DI) on the basis of two theoretical frameworks: from Nobel laureate Amartya Sen’s perspective on capabilities, which examines social regimes from the point of view of individuals' ability to make choices that they have reason to value; and the life course approach developed within the National Centre of Competence in Research LIVES, which perceives vulnerability as a lack of resources affecting several life domains, on various levels and over time.

Emilie Rosenstein's research uses both quantitative and qualitative methods and combines a wealth of data to assess the consequences of the successive DI reforms which took place in 2004, 2008 and 2012. One of the main objectives of these changes was to reduce the number of annuitants, particularly among young people suffering from mental disabilities, a category that has seen a significant increase since the 1990s.

In an attempt to achieve their goal, these reforms have followed three specific guidelines: stricter assessment of the right to benefit, earlier intervention by DI (primarily as a result of disabilities being detected earlier) and additional measures for vocational rehabilitation and labour market inclusion.

Contrasting results

Emilie Rosenstein's observations lead to contrasting results: while the number of people in receipt of the benefit has fallen sharply at national level, the proportion of the youngest beneficiaries - aged from 18 to 34 - has not decreased; around one in every two beneficiaries are in receipt of disability annuities due to mental illness.

Sequence analyses, conducted by the researcher in partnership with Prof. Felix Bühlmann from the University of Lausanne using representative samples of people in receipt of DI in the canton of Vaud, provide an insight into the trajectories of insured persons over time and across the successive system reforms.

There has been a considerable increase in the number of claims being rejected by the DI and a clearly perceptible acceleration in the processing of cases. Conversely, the provision of vocational rehabilitation measures is on the increase, although it remains marginal.

Stricter criteria and requirements

According to Emilie Rosenstein, “the decline in numbers is due to the eligibility criteria being tightened, rather than more people exiting DI, including as a result of rehabilitative measures.”

Her thesis identifies several paradoxes brought about by the successive reforms. She questions the very concept of activation in relation to people affected by health problems, who are often asked to come up with a reintegration project when they are sometimes in a state of great vulnerability.

Not the least of the contradictions here is the fact that in order to reduce expenses, the DI urges insured persons to make their declarations as soon as possible, taking the view that early intervention will prevent annuities having to be paid over the medium and long term. However, this pressure has a dissuasive effect on beneficiaries, either because they are unaware of the range of benefits provided by DI, or because their health is too unstable for them to take decisions at that stage, or because they are still in denial about their disability.

These discrepancies in timing between the DI and its insured persons are an obstacle to professional retraining. “The activation paradigm therefore appears to be profoundly paradoxical, because it increases the risk of non take-up while at the same time trying to reduce it,” the researcher notes with concern.

Risk of inauthenticity

Emilie Rosenstein believes therefore that there is a risk of “inauthenticity” in the reintegration projects, and therefore of failure if the needs and expectations of the beneficiaries are not sufficiently taken into account. “The use of the project as an insertion tool is therefore indicative of a potentially selective approach, or even one that promotes exclusion,” comments the researcher.

She is also critical of the “significant asymmetry between the individual responsibility of insured persons regarding their reintegration projects and the limited professional opportunities available.” From a capabilities perspective, Emilie Rosenstein calls for greater attention to be paid by the labour market and wider society to the “conversion factors” necessary to reduce inequalities between able-bodied people and those with disabilities, and promote real access, not just a formal right, to professional reintegration.

Feelings of ineligibility

A series of interviews with beneficiaries supports the thesis, enabling the researcher to focus on the feelings of ineligibility or shame experienced by DI users. These accounts confirm the hypothesis that a section of the insured persons engage in a kind of auto-selection and risk missing out on the benefits of DI, either because they do not understand their rights or because they refuse to be seen as disabled, or they are afraid of being stigmatised as opportunists taking advantage of the system.

Before the public defence of her thesis, Emilie Rosenstein took several opportunities to present her research to professionals in the field. Her thesis panel was particularly appreciative of her efforts to communicate with the stakeholders involved and advised her to publish her empirical results in ambitious scientific journals.

At a time when the seventh review of DI is already under way, her new title of doctor now confers on her all the legitimacy necessary to speak out for those who are not generally heard and to whom we would do well to listen more, as is shown in her work.

>> Emilie Rosenstein (2018). Activer les publics vulnérables ? Le cas de l'Assurance-invalidité. Under the supervision of Jean-Michel Bonvin. University of Geneva