Marcel Slockers

101 Accessibility to care for homeless people after the health insurance policy changes In the Netherlands, no population group can be identified with a shorter life expectancy than homeless people. A study from 2014 showed that homeless people in Rotterdam live 14-16 years shorter than the general population. 1 Street doctors were displeased when the government announced a measure by which homeless people without an address would become uninsured, just when the vulnerability of homeless people was scientifically emphasised. 2,3 Since 2015, health insurers expel people who have not been registered with the civil registry for several weeks. This concerns not only homeless people in the shelter locations, but also couch surfers; people who stay somewhere without a municipal regis- tration address. Epidemic of uninsured Street doctors in the large cities noticed an increase in the number of uninsured homeless people and observed serious consequences as a result. People were, for example, being turned away by hospital staff, even with a referral from GPs and street doctors. 2 The provided care was poor and pharmacists did not provide medication. After a trauma, patients were treated with limited surgery procedures with lifelong mobility problems as a result. Others became psychotic due to the lack of medication, or ended up in a diabetic coma in an intensive care unit. These signals caused the street doctors to raise the alarm. 3 TheAanjaagteam, a special team for disoriented people, supported the street doctors in this. Mayors also noticed that help from the GGZ, Dutch mental health care, was unavailable for uninsured disoriented people on the street. Subsidy scheme uninsured In March 2017, the Ministry of Health, Welfare and Sport started a subsidy scheme for insurable uninsured people. 4 This meant that the care provider had to report the patient within 24 hours to the GGD-GHOR Nederland www.meldpuntonverzekerdenzorg.nl. (Contact Point Uninsured). Along with this notification, the healthcare provider received a form to declare costs at the CAK (Dutch administrative body in the health and welfare field). Subsequently, GGD-GHOR Nederland forwarded the central notification to the local GGD so GGD workers were able to contact the uninsured to initiate social care, starting with an address and health insurance.