Academic journal article Social Security Bulletin

The U.S. Study of Work Incapacity and Reintegration

Academic journal article Social Security Bulletin

The U.S. Study of Work Incapacity and Reintegration

Article excerpt

The International Social Security Association recently completed a six-nation comparative study of work incapacity and reintegration that focused on workers with back disorders. This article discusses the findings of the US. national study and discusses their policy implications.


In many countries, including the United States, the number of persons being awarded long-term or permanent disability benefits has risen dramatically in recent years. Government agencies, advocates for the disabled, and others are looking for ways to help persons with disabilities return to the labor force. The Work Incapacity and Reintegration (WIR) Study was developed to address that issue.

The United States and five other countries-Germany, Denmark, Sweden, Israel, and the Netherlands-have participated in a cross-national study of work incapacity under the auspices of the International Social Security Association. The study had two objectives: to examine the factors that influence the pattern of work resumption among persons disabled by a back condition and to identify the medical and nonmedical interventions that are most effective in helping such persons reenter the labor force.

Samples for the U.S. national study were drawn from four cohorts: Social Security Disability Insurance (DI) beneficiaries, Supplemental Security Income (SSI) beneficiaries, and recipients of temporary disability insurance (TDI) benefits from the states of California and New Jersey. Only the TDI recipients were included in the comparative study. This article discusses the study design and methodology and summarizes the findings of the U.S. national study.

Findings from the U.S. study show significant differences between the two cohorts in terms of work resumption and other characteristics. The proportions of respondents from the TDI cohorts who were working at the third and final study contact ranged from 53 percent to 65 percent, compared with less than 5 percent of the DI and SSI respondents. Respondents from the DI and SSI cohorts were on average about 10 years older than the TDI respondents, were less well educated, and reported more physical demands in their usual work. They also reported lower levels of functional capacity, higher levels of pain, and a much greater tendency to have other chronic illnesses.

The types of medical treatments provided were remarkably uniform across cohorts and, within cohorts, between those who did and did not resume working. Thus, no medical intervention was identified that showed a significantly higher success rate in terms of facilitating a return to work. However, changes made in the work environment by the employer were an important factor in work reintegration; about 80 percent of respondents who resumed working did so with the help of workplace accommodations. In addition, since respondents with fewer physical demands in their job were more likely to return to work, there appears to be some potential for job retraining as a means of promoting a return to work. The Social Security Administration should consider these findings in developing strategies to help disabled workers reenter the labor force.


In the United States, as in many other countries, the number of individuals applying for and being awarded long-term or permanent disability benefits grew substantially during the 1990s. Most nations are attempting to understand the reasons for the trend and to determine what the near- and long-term trend might be so that financial impacts can be assessed. Government agencies, advocates, and others-together with individuals who have severe impairments-are seeking ways to help disabled persons to remain in the labor force or, once having left, to return to work. Simply stated, work is central to one's ability to achieve self-sufficiency, and effective efforts to return people with disabilities to work are being made throughout the world.

The United States, Germany, Denmark, Sweden, Israel, and the Netherlands participated in a cross-- national study of work incapacity and reintegration (WIR) under the auspices of the International Social Security Association (ISSA). …

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