Marcel Slockers

18 Chapter 1 the Ziekenfonds, the Dutch National Health system at the time. Once registered with the Ziekenfonds, someone would remain registered even in case of income loss. The Ziekenfonds had no deductible excess or financial contribution. Only a relatively small group of self-employed people with a private insurance would become uninsured in case of payment arrears. Since the introduction of the Zorgverzekeringswet in 2006, it is compulsory for all legal residents in the Netherlands to have health insurance. Nevertheless, different groups of people have become uninsured since then: first, 18-year olds who do not register with a health insurance company; second, people who, during detention, were covered for healthcare costs by the Ministry of Justice, but who do not register with a health insurance company after release from prison; third, Dutch people who, after long term residence abroad, do not register again with an insurance company. Since the introduction of the Zorgverzekeringswet, many homeless people have also become uninsured. In 2013, street doctors reported that 25% of the homeless people visiting their consultation hours were uninsured. According to an internal report by the GGD, this number had increased to 50% by 2015. In Nijmegen in 2014, street doctors estimated 18% uninsured people, which increased to 31% in 2015. Research conducted by the Salvation Army in Dordrecht and Venlo in 2015 showed that half of the homeless people had no health insurance. 43 Before 2015, it was not only complicated for health insurance companies to collect the nominal premium, but collecting the increasing deductible excess became more and more difficult. 44 In 2015, the increased payment arrears in nominal premiums and deductible excess led to a change in government policy, supported by all members of the Dutch parliament. 45,46 From then on, people without an address were expelled from health insurance to avoid collection problems of healthcare insurers. This new situation led to an intensive dialogue between policy makers and the Dutch Street Doctors Group by means of blogs, letters, work visits and testimony from experts. The ‘uninsured epidemic’, the rapidly growing number of uninsured people without an address, not only had a negative impact on homeless people and street doctors. Mayors of the major cities also realised they could not arrange mental healthcare for uninsured, disoriented people because the institutions refused people without an address. The special team for disoriented people, the Aanjaagteam, also emphasised the problematic situation of uninsured people. 36 Two groups of uninsured people can be distinguished: first, homeless people without an address, known as the insurable uninsured; and second, the group of uninsurable uninsured. In March 2017, a new subsidy scheme was introduced for insurable uninsured people without an address, the so called Meldpunt Onverzekerden (Contact Point Uninsured), via www.meldpuntonverzekerd.nl. 47 This scheme requires health care providers to report