Marcel Slockers

102 Chapter 7 Implementation problems In practice, several problems emerged during the process of implementing the subsidy scheme. Healthcare professionals were often not informed about the regulation and if they were, they reported that the administrative burden did not outweigh the costs to be claimed. It was unclear who was eligible for compensation . The implementation by the CAK was also complicated for care providers. In 2019, the scheme was simplified, after consultation with the Dutch Street Doctors Group and the Ministry of Health, Welfare and Sport. To be eligible for compensation of care costs, central notification to GGD-GHOR Nederland must now be done within one week, and the administrative burden and required data are reduced. Application of the scheme in Rotterdam Rijnmond Under the supervision of the first author of this article, medical students from Erasmus Medical Centre (MC) conducted research into the bottlenecks in the application of the subsidy scheme for uninsured people in the Rotterdam Rijnmond region, commissioned by the Dutch Street Doctors Group. In this context, interviews were conducted with homeless people, experts by experience with health insurance problems and policy makers, and a questionnaire was distributed among health care workers and the websites of all hospitals in this region were studied. 5,6 Interviews revealed that homeless people had been refused care or were asked for cash payment in advance. Experience experts believed that they could be actively involved in providing tailored information to the uninsured and staff at the civil registry, GGD and neighbourhood teams. As reported by policymakers, approximately 7,200 central reports were made to GGD-GHOR in the Netherlands between March 2017 and November 2018. Only 30% of the uninsured, however, were able to be insured after reporting to the local GGD. Aquestionnaire on the application of the regulation was distributed among 105 care workers and was completed by 21 of them. The respondents had different positions: doctor, nursing specialist, finance worker, healthcare administration employee, social worker or manager. Nearly all respondents (n=20) indicated they were familiar with the CAK subsidy scheme for 'medically necessary care for the uninsured'. However, only half of the interviewed care providers usually report to the CAK after medical care has been provided to an uninsured