Definition of eligibility

These features of DLA/AA imply that, whatever method is used to determine the eligible population, there will inevitably be people who having been denied the benefit by one decision maker, might have been awarded it by another decision maker. The extent to which such people are included in the estimate of the eligible population, and hence the estimate of the take-up rate, is a matter for judgement. That is why the ‘truly’ eligible population is difficult to define and the term ‘probably eligible’ may be more appropriate. The meaning of this term is explained in greater detail now.

Among any candidate population of significantly disabled people, some will be 100 per cent eligible for DLA/AA, others zero per cent; so that any system would respectively award or deny them benefit. This means that repeated applications or applications with a different presentation of the same information sent by, or on behalf of, these people to different decision makers would return with unvarying ‘yes’ or ‘no’ replies. The benefit system that bases its award decisions on the information that is less open to interpretation than DLA/AA would count the vast majority of its potential applicants in these 100 per cent or zero per cent groups. In the case of DLA/AA some people have a greater than zero but less than 100 per cent chance of an award. These are recipients whose claims might have been disallowed had a different decision maker considered their case or had information in their application been presented differently. Out of 100 claimants with identical needs relevant to the DLA/AA criteria, some, say 80 claimants, may be awarded

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the benefit and the rest may be disallowed. Whatever is the ‘true’ eligibility of this population of 100 claimants (with identical needs), one part of it (20 claimants or 80 claimants) does not seem to conform to it. The natural interpretation of eligibility would suggest that since their needs are identical all 100 claimants are either ‘truly’ eligible or ‘truly’ ineligible and should all be either awarded or not. However, in the case of DLA/AA, the split of 100 claimants with identical needs into recipients and non-recipients is not necessarily due to a mistake on the part of decision makers. Given the same information about these claimants, two decision makers may arrive at opposite decisions on the basis of their different interpretations and judgements. Moreover, since the needs of a claimant are to be reported in a free-text format, the same decision maker may arrive at opposite decisions on the same case depending on the ways the claimant’s needs are presented. The most important point to stress is that both interpretations and both decisions may be valid, even if they disagree with each other. The fact that only 80 claimants receive the benefit means that all these 100 claimants have an 80 per cent probability of being eligible.

These features of the benefit introduce the probability, or uncertainty, into the definition of eligibility for DLA/AA. The number of people who have a greater than zero but less than 100 per cent chance of being eligible is important and so is their distribution across the probability range. The solid line in Figure 1.19 _{is used}

as an example in order to illustrate the point. It shows ten per cent of people who have no chance of succeeding if they claimed, a further 20 per cent of people who if they applied 100 times would not succeed more than five times (up to five per cent chance), another ten percent who would definitely succeed (100 per cent chance), and an additional 20 per cent who have a chance of between 95 and 99 per cent (i.e. they would succeed in 95 to 99 times out of 100). The remaining 40 per cent of the population in this example have a chance of succeeding that varies between five and 95 per cent. Obviously, the greater the proportion of people in this range (‘the area of uncertainty’), the more uncertainty is associated with eligibility. On the contrary, the greater the proportion of people with a very low and a very high chance of success (i.e. the closer the solid line is to the dotted line in Figure 1.1), the less uncertainty surrounds the eligibility.

9 _{With acknowledgement and thanks to Professor Richard Berthoud.}

Figure . Distribution of claimants by their probability of entitlement

This discussion illustrates that regardless of any fraud and error problems, in the case of DLA/AA, eligibility for those who claim does not necessarily equate with receipt. Consequently, a choice of the take-up measure depends on the assumptions underpinning the definition of eligibility. There are suggestions, for example, of defining a pool of the eligible on the basis of decision makers’ assessment of DLA/AA claims obtained via a survey (Purdon et al., 2005). The eligible population in the FRS Disability Follow-up Survey that was mentioned above consisted of the disabled people who may or may not have been in receipt of an award; it excluded those who may have been in receipt of an inappropriate award, even though these people were included in the number of recipients when calculating the take- up rate (Craig and Greenslade, 1998).

This research takes uncertainty surrounding eligibility as given and adopts a probabilistic approach to its definition. This means that references to the ‘eligible’ population are always references to the ‘probably eligible’ population. Another definition used in the report refers to the population of the potentially eligible. These are people who have a disabling condition that may, or may not, render them (probably) eligible for DLA/AA. For example, a person with arthritis may be potentially eligible but will enter the pool of the (probably) eligible if their arthritis gives rise to mobility or care needs that meet the DLA/AA eligibility criteria.

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At present, the size of the potentially eligible population is unknown. The number of the probably eligible and their distribution across the probability range is not known either. The feasibility of identifying these and estimating the DLA/AA take- up rate is the subject of this research and this study is part of it. The next chapter provides detail about the research and the place of this study in it.