Marcel Slockers

112 Chapter 8 Policies may also have affected the disease pattern of homeless people. Despite improved homelessness policies between 2006-2010, the proportion of psychiatric diagnoses remained high. Since 2006, the proportion of patients with registered alcohol and hard drug problems, however, has decreased. In contrast, the proportion of patients with registered soft drug addiction, cardiovascular disease (especially hypertension), endocrine disease (especially diabetes), COPD, and oncological diseases has increased ( chapter 3 ). What have been the effects of policy changes in health insurance measures in 2015 on homeless people's accessibility of care? Asurvey of health professionals revealed that in several regions and cities in the Netherlands (including Rotterdam) the number of uninsured people at street doctor's consultation hours increased significantly from the beginning of 2015. This survey also identified factors that have impeded homeless people's access to care since 2015: characteristics of homeless people, laws and regulations, rules for accessing shelter, social care and other services. ( chapter 6 ). Findings from the survey above contributed to the launch of a new funding scheme in 2017 from the Ministry of Health, Welfare and Sport (VWS). Our research on the application of this scheme in Rotterdam showed insufficient use of the scheme due to unfamiliarity among care institutions, a reporting requirement within 24 hours and aversion to excessive administrative work. Based on these results, a flowchart was drawn up in order to help care providers and institutions to improve application of this regulation. This flowchart supports the implementation of the scheme, ensuring that health care providers and institutions are paid and that the GGD can ensure that homeless people receive help from the municipality. In 2019, the funding scheme was slightly adjusted. Despite our attempt to improve the implementation, the scheme remains very complicated, which may continue to hinder its proper application ( chapter7 ). 2. What are the limitations of this study and what was not examined? Mortality data Homeless people are a difficult group to study: an official mailing address is often not available; telephone numbers and places to stay often change; and internet contact is generally poor. Nevertheless, in our mortality study we were able to follow a very large share of the homeless people identified in 2001 for over a period of 10 years. The mortality study included not only homeless people in the shelters of municipal services, but also