Inflammatory bowel disease (IBD) is a common chronic illness in industrialized countries occurring during formative educational and early career years. Hence, IBD is likely to have a significant and detrimental impact on an individual’s labour supply (LS). This loss in productivity and earnings potential can be compensated for by revenue from disability insurance (DI). In Switzerland, DI supports people with reduced working capacity due to chronic health problems by providing assistance for professional reinsertion and financial support for lost earnings potential. Individuals can continue to receive DI while employed. Due to a rising DI fund deficit a series of policy reforms were initiated since 2008 to reduce DI expenditures.
We use longitudinal data from the Swiss IBD Cohort Study containing detailed data on patient’s disease, socio-economic and health care use to investigate trends in DI receipt and LS as well as the direct association between DI and LS for IBD patients with ulcerative colitis (UC) or Crohn’s disease (CD). Multivariate logistic regressions, conditioning on baseline and time varying characteristics, combined with propensity score matching (double robust) were estimated.
Significant increases in LS were observed for both CD and UC patients along with reductions in DI receipt over time. In 2007 CD patients were less likely to participate in the labour force than UC patients (65% and 73.5% respectively) and more likely to receive DI (20% and 9% respectively). Following the deficit reduction plan of 2008, benefit receipt started to decrease for all IBD patients, but relatively more for CD patients than UC patients. By 2013 CD patients receipt of DI had fallen by 10 percentage points. LS for CD patients increased initially by 10 percentage points [95%CI: 2.8– 17] but by 2010 the increase stopped. UC patients also experienced an increase in LS of 7.4 percentage points [95%CI: -2 – 16.9]. Double robust estimates suggest this association could be causal with loss of DI associated with a 10.9% [95%CI: -1.3% – 23.1%] increase in LS. LS however did not continue to increase for CD patients after the DI restrictions of 2011, which may not have targeted individuals able to increase their LS.