Assessing the impact of benefit sanctions on health

这项研究的目的是检查福利制裁是否导致索赔人的身体或精神健康状况恶化，或更多地利用保健服务。它还试图增加我们对制裁是否鼓励索赔人更快重返就业的了解。这项建议的创新之处在于使用了一个个人福利、就业和健康史数据库，该数据库是根据以前没有联系过的行政记录建立的。申请某些福利的人，特别是求职者津贴（JSA）和工作相关活动组（ESA WRAG）的就业和支持津贴申领人，有附加条件。以JSA为例，申请人必须定期在就业中心办公室登记，并采取一定的步骤来找工作。如果他们不能满足这些条件，他们可能会受到制裁，即在一段时间内停止他们的福利。失业救济一直都是有条件的，但近年来这些条件有所增加，制裁的次数和最长期限也在增加。通用信贷的引入使条件扩大到在职人员，并提高了早期案件的制裁率。制裁旨在确保人们尽快重返工作岗位。这对公共财政有利，因为它降低了申请人数；对经济有利，因为它保持了劳动力供应；至少可以说，对申请人有利，因为失业往往对我们的健康有害。然而，批评人士认为，制裁可能会产生意想不到的副作用：损害索赔人的健康，增加无家可归者，或给影响儿童福利的家庭带来压力。对健康的影响可能来自食物或取暖开支的限制，也可能来自试图应付没有收入的心理压力。这些意想不到的影响可能导致公共服务支出增加，抵消福利申请减少带来的节省。关于与制裁有关的这些意外影响的研究很少，而且几乎没有研究能够提供令人信服的证据，证明制裁会造成伤害。提议的研究我们将结合工作和养老金部（DWP）和苏格兰国民保健服务（NHS）的行政记录中的信息，建立一个个人福利、工作和健康史的数据库。这些数据是敏感的个人信息，所以我们需要特殊的权限才能访问它们，我们正处于保护的最后阶段。该数据库将涵盖2010-17年在苏格兰申请JSA或ESA WRAG的人。我们把重点放在苏格兰，因为健康数据目前只在这里可用。从DWP那里，我们得到了索赔咒语的记录以及人们是否被制裁了。从苏格兰国家医疗服务体系，我们可以获得以下信息：可以指示各种身体和精神健康状况的药物处方；使用意外和紧急情况或计划外住院，这可能表明由酗酒等危险行为或因饮食不良、压力等导致的慢性病恶化引起的事件；死亡率数据，包括自杀。我们还将审查错过的预约，因为这是保健服务的一个重大问题。从2013年10月起，DWP可以提供就业时间的数据，这样我们就可以研究这一时期制裁对劳动力市场的影响，从而判断是否有任何健康影响取决于人们是否找到有薪工作。我们的分析面临的主要挑战是证明制裁是否会导致健康方面的变化。要做到这一点，我们必须排除其他因素的可能性，这些因素意味着更有可能受到制裁的人往往健康状况也更差；例子可能包括毒品或酒精问题，或家庭危机，如丧亲之痛。有各种各样的技术可以让我们做到这一点。这项研究的结果将为有关最近福利变化的学术辩论提供依据，但也旨在对这一领域的政策产生影响。

The aim of this research is to examine whether benefit sanctions lead to claimants having worse physical or mental health, or making greater use of health services. It also seeks to add to our knowledge on whether sanctions encourage claimants to return to employment more quickly. The proposal is innovative in using a database of individuals' benefits, employment and health histories constructed from administrative records which have not previously been linked. BackgroundPeople who claim some benefits, especially Jobseeker's Allowance (JSA) and Employment & Support Allowance claimants in the Work-Related Activity Group (ESA WRAG), have conditions placed on them. With JSA, for example, claimants must sign on at the Jobcentre Plus office regularly and take certain steps to find work. If they fail to meet these conditions, they can be sanctioned, i.e. their benefits are stopped for a period. There have always been conditions on unemployment benefits but they have increased in recent years, with the number of sanctions and maximum length rising. The introduction of Universal Credit has seen conditions extended to those in work as well as higher sanction rates for early cases. Sanctions are meant to ensure that people return to work as soon as they can. This is good for public finances as it keeps claims down, good for the economy as it keeps labour supply up and, arguably at least, good for claimants since unemployment tends to be bad for our health. However, critics argue that sanctions may have unintended side-effects: harming claimant health, increasing homelessness, or putting stress on families which affects child welfare. Health effects may arise from restricted spending on food or heating but also from the psychological stresses of trying to cope without income. These unintended impacts could lead to greater expenditure on public services, off-setting savings from reduced benefit claims. There has been very little research on these unintended impacts associated with sanctions, and almost none which can provide convincing evidence that sanctions cause harm. Proposed researchWe will construct a database of individuals' benefit, work and health histories by combining information held in the administrative records of the Department for Work and Pensions (DWP) and NHS Scotland. The data are sensitive, personal information so we need special permissions to access them which we are in the final stages of securing. The database will cover people who claimed JSA or ESA WRAG in Scotland for 2010-17. We focus on Scotland because the health data are currently only available here. From DWP, we get records of claim spells and whether people were sanctioned. From NHS Scotland, we get information on: the prescribing of medicines which can indicate various physical and mental health conditions; use of Accident & Emergency or unplanned hospital admissions which can indicate incidents arising from risky behaviours such as alcohol abuse or the worsening of chronic conditions due to poor diet, stress, etc.; and mortality data, including suicides. We will also examine missed appointments since these are a significant concern for the health services. From Oct 2013 on, DWP can provide data on employment spells so we can look at the labour market impact of sanctions in this period, and hence whether any health effects depend on whether people find paid work or not. The main challenge for our analysis is to show whether sanctions cause a change in health. To do this, we have to rule out the possibility that there are other factors which mean that the people who are more likely to get sanctioned also tend to have worse health; examples might include a drug or alcohol problem, or a domestic crisis such as a bereavement. There are various techniques which let us do this. The results of the research will feed into academic debates about the recent changes to welfare but are also intended to have an influence policy in this area.