Judging without criteria? Sickness certification in Dutch disability schemes

Abstract

The gate-keeping function that physicians perform in determining clients' physical and mental incapacities is widely assumed to be the main reason for the rising numbers of disabled people. The sharp rise in the number of disabled has led many to claim that the disability benefits schemes are untenable. In order to regain public control and to make disabled eligibility procedures more transparent guidelines have been introduced in which medical evaluations are conceptualised as formal rational decisions. It is, however, questionable whether such measures are helpful in achieving their stated aims. This paper is based on ethnographic research on the ways physicians evaluate the eligibility of clients for disability benefits. It argues that assessing incapacity involves much more than formal rational decision-making. Doctors' reasoning is contextual and deliberative in character, and thus their assessment of a client's incapacity is less a technical matter than a normative one. Instead of generating transparency, guidelines based on formal rationality make the complex deliberations on which such judgments are based invisible, because they deny the normative dimension of medical expert decision-making. Therefore, different measures have to be developed that allow this normative dimension to be articulated, since insight into this normative dimension is a necessary pre-condition to be able to criticise disability judgments at all.

Stereotyped perceptions of chronic pain

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How policy on employee involvement in work reintegration can yield its opposite: employee experiences in a Canadian setting

“…For example, proposed bipartite solutions in reintegration activities could influence work modifications or accommodations but lacked binding authority to ensure implementation. Some scholars explain policy implementation difficulties in continually reforming work reintegration policy [14], its unintended consequences [15], and because of too many rules on forced collaboration [16,17].…”

Preserving workers' dignity in workers' compensation systems: An international perspective

“…On the one hand, trade unions and collective agreements have been found to play a more important role in providing higher levels of salary replacement to the sick and disabled, as public systems have undergone cutbacks [Yerkes and Tijdens, 2010]. On the other hand, in order to reduce dependency on disability insurance, attempts have been made to gain control of physician gatekeepers by providing them with guidelines in disability assessments [Meershoek et al, 2007] and by promoting ''evidence based'' insurance medicine [Kok et al, 2008].…”