2013-02-04
National Audit Office: difficult puzzles of determining disability and capacity for work and ineffective vocational rehabilitation of the disabled
Social security in the event of loss of capacity for work is a legitimate expectation of members of the public. Due to limited state resources and social vulnerability of people with disabilities it is important to aim at satisfying this expectation by distributing the available resources in the most equitable way. The National Audit Office conducted an audit to assess whether the level of capacity for work and disability is determined objectively and to evaluate effectiveness of vocational rehabilitation of the disabled. Auditor General Giedrė Švedienė summed up the audit findings as follows: “The process of determining the capacity for work level has serious flaws; as a result, it is those who really need the state support who suffer most. Vocational rehabilitation has not been effective either because it does not ensure integration of the disabled into the labour market.”
Doubts about objectivity of decisions on determination of the level of capacity for work arise because of the fact that the largest number of the disabled is registered in the municipalities where the unemployment rate exceeds the national average. In addition, part of the people who receive pensions for incapacity for work have not been taking compensated vital medicinal products. The incapacity for work pension should be paid to compensate for the loss of income from work however, in 39 per cent cases examined, the salary of persons who had been working before determination of their capacity for work for the first time not only did not go down but actually increased. Also, cases have been observed when the disabled earn 10-30 times more than the amount of pensions paid thereto, or when persons with severe or moderate disabilities work in 3 or 4 workplaces. Pensions for incapacity for work in other EU countries are differentiated according to the lost income and received income. Seeking greater objectivity, incapacity for work pensions could be reduced gradually for those who are able to work but are unemployed, and increased for persons who are not able to integrate in the labour market due to objective reasons. Disability-related additional costs incurred by the disabled should also be compensated.
The Disability and Working Capacity Assessment Office (the Office) is not always able to make the right decisions regarding the capacity for work level or special needs. In case of doubt, the Office has no powers to call independent experts to verify the diagnosis and to perform additional examination. In addition, determination of the capacity for work level is mainly influenced by medical criteria and not by the person’s actual capability to work. The Office has not sought access to databases containing information about the person’s medical treatment and work relationships, therefore its decisions on the capacity for work level have been usually taken only on the basis of the oral information and paper documents provided by the person. Besides, the Office has not developed any system for the assessment of risks of its decisions, i.e. there are no criteria for the selection of decisions for scheduled control, and the existing control is ineffective due to its small scope.
The annual amount of funds allocated for vocational rehabilitation of the disabled in 2009-2011 is about LTL 10 million on average. Vocational rehabilitation is most effective if assigned when determining the capacity for work level for the first time because persons who have not worked for a long time loose their social skills and qualifications. However, in 2011 such demand was identified during primary determination of the capacity for work level only for 3.4 per cent of the disabled who took part in vocational rehabilitation. To a certain extent, this was due to vague criteria for the selection of persons for vocational rehabilitation. Vocational rehabilitation centres failed to ensure that the disabled could choose a training program that suits their capabilities and capacities for work. The implementation of the programmes was not cost-effective because more than half of them involved up to 5 people, mainly persons with low disability who could have been included in 3-8 times cheaper formal vocational training programs. Only 30 per cent of 511 persons with disabilities who completed vocational rehabilitation in 2011 participated in the labour market for more than 2.5 months. Few disabled after their vocational rehabilitation are employed in social enterprises.
The National Audit Office provided recommendations to the Ministry of Social Security and Labour, Ministry of Health, and the Disability and Working Capacity Assessment Office.