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Too sick to work, too healthy to qualify: a cross-country analysis of the effect of changes to disability benefits
  1. Natasja Koitzsch Jensen1,
  2. Henrik Brønnum-Hansen1,
  3. Ingelise Andersen1,
  4. Karsten Thielen1,
  5. Ashley McAllister2,
  6. Bo Burström2,
  7. Ben Barr3,
  8. Margaret Whitehead3,
  9. Finn Diderichsen1
  1. 1 Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  2. 2 Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden
  3. 3 Department of Public Health and Policy, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Natasja Koitzsch Jensen, Department of Public Health, University of Copenhagen, Copenhagen 1014, Denmark; naje{at}


Background Denmark and Sweden have implemented reforms that narrowed disability benefit eligibility criteria. Such reforms in combination with increasing work demands create a pincer movement where in particular those with moderate health problems might be unable to comply with work demands, but still not qualify for permanent disability benefits, ending up with temporary means-tested or no benefits. This paper examines whether this actually happened before and after the reforms.

Methods The Survey of Health, Ageing and Retirement in Europe (SHARE) study waves 1–2 and 4–6 in Denmark and Sweden for the age group 50–59 years (N=5384) was used to analyse changes in employment rates and benefits among people with different levels of health before, during and after disability benefit reforms. Interaction between time and health in relation to employment versus permanent or temporary benefits was used as a criterion for whether our hypotheses was confirmed.

Results Overall, employment rates have increased in the age group, but only among the healthy. The OR for receiving temporary or no benefits increased from 1.25 (95% CI: 0.81 to 1.90) before to 1.73 (95% CI: 1.14 to 2.61) after policy reforms for the 29% with moderate health problems and from 2.89 (95% CI: 1.66 to 5.03) to 6.71 (95% CI: 3.94 to 11.42) among the 11% with severe health problems. The interaction between time and health was statistically significant (p<0.001).

Conclusion People with impaired health and workability are forced into a life with temporary means-tested or no benefits when pressed by rising work demands and stricter disability benefit eligibility criteria.

  • health policy
  • social inequality in health
  • social epidemiology
  • health reforms
  • social security

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  • Contributors NKJ, HBH, IA and FD designed the study. NKJ and HBH made the analysis. NKJ and FD drafted the first version of the manuscript. KT, AM, BBu, BBa, MW contributed to the interpretation of the results. All authors provided comments on earlier versions of the manuscript. All authors read and approved the final manuscript.

  • Funding The study is part of a larger project entitled Tackling Health Inequalities and Extending Working Lives (THRIVE). The funders were The Innovation Fund Denmark (5194-00004B), the Swedish Research for Health, Working Life and Welfare (2015-01531),The UK Economic and Social Research Council (ES/N019261/1) and was also supported by The Joint Programme Initiative More Years, Better Lives.

  • Disclaimer The funding agency had no role in design or analysis of the study. The views expressed in this paper are those of the authors and not necessarily of the funding agency.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Danish team do not need ethical approval to use the SHARE data as ethics approval is only required when using biological materials. For Swedish data, the Swedish team received ethical approval to use the SHARE data from the Regional Ethical Review Board of Stockholm (Dnr 2016/1353-31/5) Additionally, the SHARE project is submitted to continuous ethics reviews. From wave 4 and onwards SHARE has received ethical approval from the Ethics Council of the Max Planck Society. The last ethics approval was granted on 4 March 2016 (

  • Provenance and peer review Not commissioned; externally peer reviewed.