than 40 percent of program clientele. "People with such conditions," according to Vachon, "are difficult to treat and represent a small fraction of the work-disabled." His claim of an imbalance is supported by LaPlante's (1989b) analysis of the disability risks of chronic impairments, which found that about 1 million people, or about 3 percent of the population with activity limitations, have a form of mental illness. However, the inference that people with a mental illness are not appropriate targets of public vocational rehabilitation services is likely to foster considerable disagreement. In fact, anecdotal evidence indicates that shrinking labor supplies have increased private-sector interest in employing people with mental impairments. Firms that have reportedly increased hiring of workers who are mentally retarded or who have other disabilities include Marriott, Pizza Hut, McDonald's, United Airlines, and the International Business Machines Corporation (Kilborn, 1989).

Disagreement over the targeting of rehabilitation services is emblematic of the ferment in the field, which in turn exacerbates conflicts and contradictions inherent in public programs and their guiding policies. Debate over these issues could be constructive if it leads to a set of complementary goals and a rational set of services.

The boundaries of this debate should be expanded to take the experiences of other nations into account. Though international comparisons are limited, the few that have been conducted draw attention to this country's fragmented approach to addressing the financial and rehabilitation needs of people with disabling conditions. A six-country comparison found that only the United States failed to provide a "continuum of care" that creates an "environment conducive to reintegration into the work force" (Beedon and Zeitzer, 1988).

In the United States, individuals are often required to prove—before receiving rehabilitative care—that their disabling condition prevents them from working. In the Netherlands, West Germany, Switzerland, Israel, and Austria, rehabilitation usually precedes decisions on permanent disability pensions. The flexibility of programs in these countries permits extension of temporary financial benefits to accommodate continuing rehabilitation aimed at improving or restoring the skills necessary for returning to work.

Also notable is the combination of employer incentives and employee benefits that the foreign nations use to foster the return of people with disabling conditions to the work force. Public funds pay for adapting the job site to the workers' needs, whereas in the United States, tax incentives are used to elicit employer cooperation. Some of the foreign nations have instituted measures that address the transportation needs of workers with disabling conditions. Sweden, for example, pays for adapting vehicles for work-related transportation, and West Germany provides an allowance to help pay the cost of traveling to work.

The United States should more carefully consider the approaches used in



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