Marcel Slockers

19 General introduction these insurable uninsured people to the contact point within 24 hours. The local GGD can then initiate care and at the same time provide the homeless people with an address and healthinsurance. The provider can rely on payment via CAK (Dutch administrative body in the health and welfare field). 48 In 2017 and 2018, however, only 30% of these cases in Rotterdam led to the uninsured being insured again. Despite the introduction of the new scheme, many cases of denial of care were reported. Therefore, the Dutch Ministry of Health, Welfare and Sport, urged by the Dutch Street Doctors Group, introduced a better scheme. Notifications at the contact point must now be made within a week. The second group of uninsurable uninsured, partially homeless people are undocumented people, who are not legally entitled to have health insurance under the so-called Koppel- ingswet, (a Dutch law which links entitlement to services to legal residence). Since 1995, in part due to the efforts of street Doctors and HIV-organisations, this group of people had had access to primary healthcare and were entitled to GP care and pharma- ceutical or obstetric care. This was absolutely essential, for example, to finance medication for undocumented, homeless, HIV-infected prostitutes. Secondary healthcare costs of undocumented people were covered by the so called Bad Debts scheme for hospitals. After the introduction of the Zorgverzekeringswet in 2006, the Ministry of Health, Welfare and Sport, assuming there were no longer any bad debts, abandoned the Bad Debts scheme. However, especially in the large cities, secondary healthcare for uninsurable, undocu- mented people remained essential. In 2008, the Klazinga Commission, after an assessment of problems caused by the new situation, made recommendations that were accepted by the Dutch government. Undocumented people, also called undocumented foreigners, should be entitled to the same healthcare as people who have basic health insurance without additional coverage. Subsequently, providers of primary, secondary and tertiary care were compensated via CAK for a substantial part of the costs of care for undocumented people. 49 5. What is known, internationally and in the Netherlands, about the effectiveness of policy and interventions regarding homelessness and health problems and mortality among homeless people? Systematic reviews show that interventions involving case management and help aimed at reduction of substance abuse are successful in reducing the number of homeless people. 4,9 Dutch studies about the Action Plan for Social Support 2006-2010 also show that early interventions help to prevent homelessness. 29 Different systematic reviews tend to reflect that social interventions have positive impacts regarding health problems and mortality among homeless people. 4,9,50,51,52 Primary healthcare programmes specifically aimed at homeless people can result in better health among homeless people than regular primary care. 49 Housing of homeless people seems to be related to a reduction in substance abuse,