Marcel Slockers

21 General introduction In the context of this thesis we have therefore conducted research on the following two main questions: 1. What is the health status of homeless people in Rotterdam, measured in terms of mortality rates and health problems as presented at the street doctor’s consultancy hours? 2. What have been the impacts of recent policy measures ,i.e. the Action Plan for Social Support (2006-2010) and changes in health insurance policy (2015) on the health of homeless people and accessibility of care, respectively. 7. Outline of this thesis This thesis is divided into chapters which provide answers to the different parts of the main questions mentioned above. In chapter 2 , we present the outcome of research conducted into mortality and life expectancy of a specially designed cohort of homeless men and women in Rotterdam, who were followed from 2001 to 2010. These results are compared to mortality and life expectancy figures of the general population in Rotterdam. Chapter 3 describes which health problems were observed during the Rotterdam street doctor’s consultancy hours in the period 2006-2017. Data used in this chapter come from the street doctors’ General Practitioner’s information system. Characteristics of homeless people who visited the consultancy hours were analysed for three 4-year periods during which significant societal developments took place: 2006-2009, 2010-2013, 2014-2017. Chapter 4 presents an analysis comparing the total mortality rate in the cohort of homeless people in chapter 2 , before and after the introduction of the Action Plan for Social Support, 2006. In chapter 5 we present the most important causes of death among homeless people in Rotterdam, and we evaluate whether and how these figures have changed since the intro- duction of the Action Plan for Social Support, 2006. In chapter 6 problems are identified which affect accessibility of healthcare for homeless people after policy changes in health insurance in 2015. These identified problems are based on information from interviews with homeless men and women and on conversa- tions between street doctors and members of the local and national governments and other organisations.