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

Covered by Dutch newspapers Financieel Dagblad and NRC and by Radio 1

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:


Why 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, 107 (4810), 258-260, 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

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.

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.

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 inequality 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.


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