Particular issues affect the determination of disability among older workers. For example, some countries have early retirement provisions which require that a limiting health condition is present, without imposing the stringent medical conditions of the main disability assessment. Other countries have allowed older workers onto disability benefits in preference to classifying them as unemployed. These systems are now faced with the policy problem of reducing early retirement and raising the effective retirement age. One way to do this is to tighten up on the medical criteria for getting a disability classification and so being exempted from the requirement to seek paid work The OECD (2003) has found that, in general, states which impose rigorous medical conditions for receipt of disability benefits appear to make fewer awards. One indicator of strong medical scrutiny is that the institution undertakes its own medical investigations and employs its own doctors, instead of relying on outside medical reports. Another indicator concerns the scope of the medical investigation: whereas in the UK the medical report is limited to determining a person's functional capacity, some continental institutions investigate the medical diagnosis and review the programme of medical treatment. (In several countries, a single insurer finances health care services and sickness and disability cash benefit provision, so the ‘treating doctor’ and the ‘benefits doctor’ are working for the same institution.)
However, it only makes sense to tighten up the medical adjudication of disability if one is convinced that the medical criteria are meaningful. Restrictive medical requirements can lead to institutions making distinctions between people with similar needs that are hard to justify. For example, older workers may have minor limiting health conditions compounded by restricted opportunities to change their area of work. This may mean that the administrative practices associated with the unemployment category are not suitable, while at the same time the medical requirements for disability benefits are not met. Social security systems might respond better to the needs of this group if they adopted a unified ‘flexible retirement’ category in which medical criteria were not central, rather than seeking to establish clear borderlines between disability, unemployment and old age (Mabbett, 2003b).