Research
Working papers
Is Delayed Mental Health Treatment Detrimental To Employment?
Job Market Paper
R&R at Review of Economics and Statistics
Dutch policy article:
Kans op werk daalt door lange GGZ-wachtlijsten
ESB, August 2023
Media coverage: Financieel Dagblad, NRC and Radio 1
Podcast (in Dutch): Nieuwe Economen Podcast
The increasing prevalence of mental health problems and limited capacity of healthcare providers have resulted in long waiting times for mental health treatment in many countries. Using administrative data on mental health treatment and labor market status for all inhabitants of the Netherlands, I find that these waiting times for mental health treatment have substantial repercussions on labor market outcomes for at least five years after the start of treatment. A two-month (one standard deviation) increase in waiting time results in a four percentage point decrease in employment probability and a two percentage point increase in the probability of disability benefit receipt. I instrument individual waiting times using regional waiting times to account for endogeneity. Furthermore, I show that vulnerable groups with low education levels or migration backgrounds are especially affected given both that the impact of waiting time is larger for them and that their average waiting time is significantly longer.
Timelapse of waiting times:
TimelapseWachttijden.mp4Why Do Temporary Workers Have Higher Disability Insurance Risks?
Joint with Pierre Koning and Paul Muller
IZA Discussion paper series, No. 15173, March 2022
R&R at Labour Economics
Dutch policy article:
Werkgeversverplichtingen bij ziekte ook effectief bij tijdelijke werknemers
Joint with Pierre Koning and Paul Muller
ESB, June 2022
We show that workers with fixed-term contracts are substantially more likely to apply for and be awarded disability insurance (DI) benefits than permanent workers. We decompose this differential into (i) selection of worker types into contracts, (ii) the impact of contract type on health, (iii) differences in employer support during illness, and (iv) differences in labour market prospects of ill workers. We find that selection actually masks part of the differential, whereas the impact of contract type on health is limited. In contrast, differences in employer incentives and labour market prospects during illness jointly explain more than 90% of the difference.
Work in progress
Sick or Unemployed? Examining Transitions into Sickness Insurance At Unemployment Benefit Exhaustion
Joint with Pierre Koning
Submitted
Spikes in exits at unemployment insurance (UI) benefit exhaustion are often seen as evidence of workers' moral hazard. Using administrative data we document a spike of out-of-labor force exits into sickness insurance (SI) at UI benefit exhaustion. Comparing detailed health and labor market characteristics of exits cohorts before and at benefit exhaustion, we show that the spike is unlikely to be driven by moral hazard of relatively healthy workers. Instead, our results point to catch-up effects of initial non-take-up of SI benefits by workers with substantial mental and physical health conditions. These results oppose earlier work on substitution between UI and SI benefit schemes and have very different policy implications.
The long-term consequences of mental health screening in high school
While the prevalence of mental health issues is high during childhood, only half of all children suffering from these issues receive treatment. The uptake of treatment is lower among children with low SES and/or migration backgrounds. This could potentially further increase inequality in later-in-life outcomes. This project analyses the introduction of preventative mental health screening for all 15/16-year-old high school students in the Netherlands. As a first step, (the heterogeneity in) the impact on the actual uptake of treatment is estimated. The second step examines whether preventive mental health screening also has long-term (10 years) effects on educational and labour market outcomes.
Talking through our mental problems
The first line of treatment for many mental health problems is some form of talk therapy. Medical RCTs often show significant positive impacts of this form of treatment on the severity of symptoms and recovery. However, little is known about how the widespread introduction of talk therapy substitutes for or complements other forms of treatment (i.e. pharmaceuticals). Additionally, impacts of talk therapy on labor market outcomes of individuals suffering from mental health problems are also unknown. In this project I examine the national roll-out of an easily accessable form of talk therapy offered at general practitioner offices in the Netherlands. I first focus on impacts on alternative forms of treatment such as pharmaceuticals and more specialized mental healthcare. Next, I examine the impact of labor market outcomes.
Spinoff waiting times for mental health treatment: Deaths of despairs and children
In this project, I examine further impacts of waiting times for mental health treatment. The first part of the project focuses on the role of waiting times on death of despairs related outcomes such as addiction and suicide. The second part of the project examines the impacts of waiting times on children's outcomes.
Activating rejected DI applicants: The impact of additional reintegration services
Joint with Pierre Koning
Individuals whose application for disability insurance (DI) benefits is rejected often end up on unemployment insurance (UI) benefits . Standard reintegration services offered to UI recipients are however often not effective for these rejected DI applicants. In this project, we evaluate a policy reform which increased the provision of reintegration services to rejected DI applicants in the Netherlands. We first assess which subgroups are likely to make use of these services, and secondly, we assess the effectiveness of the additional service provision on both employment outcomes and on healthcare utilisation.
Publications
Do Disability Benefits Hinder Work Resumption After Recovery?
Joint with Pierre Koning and Paul Muller
Journal of Health Economics, Volume 82, March 2022
2021/2022 SBE-Tinbergen best PhD publication award
While a large share of Disability Insurance recipients in OECD countries are expected to recover, outflow rates from temporary disability schemes are typically negligible. We estimate the disincentive effects of disability benefits on the response to a (mental) health improvement using administrative data on all Dutch disability benefit applicants. We compare those below the DI eligibility threshold with those above and find that disincentives significantly reduce work resumption after health improves. Approximately half of the response to recovery is offset by benefits. Estimates from a structural labor supply model suggest that disincentives are substantially larger when the worker's earnings capacity is fully restored.tem
