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IZA Discussion Paper No. 18799
July 2026
Does Stricter Disability Screening Lead to Improved Targeting on Long-term Health and Employment Outcomes?
Chiara Campana, Pierre Koning, Maarten Lindeboom

While evidence points at potentially strong effects of stricter screening and tightening eligibility criteria for Disability Insurance (DI), little is known about their targeting effects: are screened-out workers also those with better future health and more ability to work? To shed light on this, we employ Regression-Discontinuity-in-Time regressions that compare the long-term outcomes of DI application cohorts just before and after a reform in the Netherlands. The reform led to stricter screening in the sickness period before DI application and reduced the number of applicants by 33%. Up to 18 years after application, we find persistently lower survival rates and lower employment rates of post-reform cohorts. Using detailed information on the future chronic diseases of these cohorts and the application diagnoses, we next construct indices capturing long-term expected survival (a “Survival Health Index”, SHI) and long-term employment prospects (a “Work Ability Index”, WAI). We find that the self-screening induced by the reform was stronger for applicants with work disabilities than for health disabilities. This is largely due to a decline in applications of workers with mental and musculoskeletal health conditions .

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