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Creative Disability Classification Systems Creative disability classification systems To the memory of Antonis Pavlis Studies from the Swedish Institute for Disability Research 87 ANTONIA PAVLI Creative disability classification systems The case of Greece, 1990-2015 Cover photo: Stelios Petros Chalas © Antonia Pavli, 2017 Title: Creative disability classification systems: The case of Greece, 1990-2015 Publisher: Örebro University 2017 www.publications.oru.se Print: Örebro University, Repro 8/2017 ISSN 1650-1128 ISBN 978-91-7529-204-5 Abstract Antonia Pavli (2017): Creative disability classification systems: The case of Greece, 1990-2015. Studies from the Swedish Institute for Disability Research 87. Disability classification systems belong to the core of states’ social/disability policies through which persons with disabilities are classified as eligible or ineligible for having access to disability allowances. The study of disability classification systems has stimulated the interest of several scholars from the broader area of disability studies. Either by conducting comparative studies between different states and describing the similarities and differences of these systems around the world or by conducting studies focusing on the politics and semantics in the development of disability classification systems in specific states, all studies have shown a pluralism in the systems for as- sessing and certifying disability. In Greece, the development of disability classification systems for social welfare reasons emerged as a controversy that lasted for almost twenty years. One factor that strengthened the con- troversy was the outbreak of the economic crisis late in 2009 followed by the announcement by the governmental authorities of the enactment of a new system for assessing and certifying disability as part of the austerity- driven policies that the Greek state would enact for facing the consequences of the economic crisis. Drawing on an interdisciplinary approach, the overall aim of this study is to describe and analyze the enactment of disability classification systems in the context of Greek social policy from 1990 to 2015. For the collection of empirical material, a qualitative research method was employed, consisting of interviews, written material, and newspaper articles. The main findings of this thesis are: I) the involvement of the political parties in the development of the systems for certifying and assessing disability; II) the involvement of the disability movement in policy- making; III) the “creative” use of statistics by governmental authorities for the enactment of disability/social policies; IV) how the concept of “disability fraud” has been constructed as a “threat” to the society; and V) the vulnerability of disability classification systems in times of austerity. Keywords: classification system, statistics, medicalization, disability move- ment, disability fraud, corporatism, economic crisis, STS, disability theory. Antonia Pavli, School of Health Sciences, Örebro University, SE-701 82 Örebro, Sweden, [email protected] Table of Contents ACKNOWLEDGEMENTS ABBREVATIONS 1. INTRODUCTION: BACKGROUND, RESEARCH AIM, THEORETICAL FRAMEWORK AND PREVIOUS STUDIES ............... 19 1.1 Background, research aim, and research questions ............................. 19 Background .......................................................................................... 19 Research Aim ....................................................................................... 21 Research Questions .............................................................................. 21 Structure of the thesis ........................................................................... 22 1.2 Theoretical framework ....................................................................... 23 1.2.1 The politics of numbers: Disability statistics and policy-making . 24 1.2.2 Classifications schemes and politics of change ............................ 26 1.2.3 Conceptualizing disability and the role of the disability movement . ............................................................................................................. 30 1.2.3.1 The mobilization of persons with disabilities and the emergence of the social model of disability ............................................................ 31 1.2.3.2 Critiques to social model of disability and the emphasis on the disability experience ............................................................................. 33 1.2.3.3 The disability movement as a new social movement ................ 34 1.2.4 The political economic theories of corporatism and clientelism and their role in the designing of disability/social policies .................... 39 1.2.5. Summary .................................................................................... 41 1.3. Previous Studies ................................................................................ 42 1.3.1 Disability and classification schemes ........................................... 44 1.3.1.1 Barema Classification Scheme .................................................. 44 1.3.1.2 Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) classification schemes ......................................... 45 1.3.1.3 The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) ...................................................................... 46 1.3.1.4 The International Classification of Functioning, Disability, and Health (ICF) ......................................................................................... 47 1.3.2 Assessing disability: The plurality of the disability assessment procedure ............................................................................................. 50 1.3.3 From the “welfare state” to the “workfare state”: Assessing disability in neoliberal times ................................................................. 53 1.3.4 The financial crisis of 2007–2008 and its consequences for the award of disability benefits .................................................................. 56 1.3.5 The disability movement and its involvement in policy-making .. 57 1.3.6 Summary ..................................................................................... 59 2. METHOD ............................................................................................ 61 2.1 Data collection ................................................................................... 61 2.1.1 Interviews .................................................................................... 63 2.1.2 Written Material ......................................................................... 65 2.1.3 Newspapers ................................................................................. 67 2.2 Field Issues ......................................................................................... 69 2.2.1 From enthusiasm to access denied ............................................... 69 2.2.2 Economic crisis and political instability ...................................... 71 2.2.3 Terminology ................................................................................ 73 2.3 Data analysis ...................................................................................... 74 2.3.1 Situational analysis ...................................................................... 75 3. THE CRISIS OF THE SOCIAL SECURITY SYSTEM AND DISABILITY: THE DEVELOPMENT OF THE IKA DISABILITY CLASSIFICATION SYSTEM (1990–1993) .............................................. 79 3.1 Social security system in crisis and disability pensions ........................ 80 3.2 Negotiations, conflicts and exclusions in the social dialogue for the enactment of the disability classification system ....................................... 83 3.3 Shedding light on the material components of the disability classification system ................................................................................. 86 3.3.1 Classifying disability into three categories ................................... 87 3.3.1.1 The role of disability statistics in the development of the first component of the disability classification system and the alleged disability fraud ..................................................................................... 90 3.3.1.2 Putting the new disability classification scale into use and the reassessment of disability beneficiaries ................................................. 92 3.3.2 The establishment of the Special Physicians’ Body of Health Committees of IKA as the gatekeepers to disability allowances ............ 93 3.3.3 The practical politics in the enactment of the Regulation for Disability Degree Assessment (KEVA) .................................................. 96 3.3.3.1 Reconstructing the KEVA ........................................................ 98 3.4 Constructing “disability fraud” ........................................................ 103 3.5 Conclusion ....................................................................................... 108 4. DISABILITY CARD (1994–2003) ...................................................... 113 4.1 Evaluating the existing system(s) for awarding disability allowances: Multiple voices share their knowledge ................................................... 114 4.1.1 The operation of the systems for assessing and certifying disability through the experiences and knowledge of persons with disabilities .. 118 4.1.2 The fragmentation of the welfare state
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