Marcel Slockers

47 Health status of homeless people measured by health problems Introduction The homeless people who visit the Dutch street doctor’s consultation hours are people who sleep outside, or in a car, shed or little boat. 1 They also sleep at the night shelter of the Centrum voor Dienstverlening (CVD) – a large welfare organisation in Rotterdam – or at the Salvation Army shelter. There are other homeless people who have accommodation for the night but who have neither an address nor health insurance. In Rotterdam, they are known as couch sleepers. Other visitors of the street doctor’s consultation hours are uninsurable people, such as undocumented migrants or Europeans who are not eligible for Dutch insurance. The Netherlands saw an increase in the number of homeless people from 18,000 to 39,000 between 2009 and 2018. 2 Homelessness often coincides with poor health 3,4,5,6 and shorter life expectancy. 4,7 Homeless people die 11 to 16 years earlier than other Dutch people 7 and, relatively often, not from natural causes . 8 Since 2003, street doctors in Rotterdam have been monitoring patient contacts at six different locations. In the early stages of this project (2005), data on 250 homeless patients were published. 3 The most frequent complaints were problems in the musculoskeletal system, psychological issues and lung conditions. Much has changed since the beginning of the street doctor’s consultation hours. At the outset, most patients were covered by the Ziekenfonds, the Dutch National Health Service at the time. Under the, Zorgverzekeringswet , the new Dutch Health Insurance Act in 2006, the former National Health Service stopped, dental care was no longer covered and patients had an, initially small, deductible excess. In the period 2006-2010, anAction Plan for Social Support for 10,000 homeless people (3,000 in Rotterdam) was implemented. Housing, more mental health care and daytime activities were provided. Between 2010 and 2013, the afore mentioned deductible excess went up. Subsequently, in the period 2014-2017, people who had no address were no longer insured, and many nursing homes closed down. Adequate provision of healthcare requires insight into the demographic and medical characteristics of the homeless population. Street doctors and nurses are concerned about homeless people’s health, 9 but there are hardly any research data available on the visitors to their consultation hours. It is still unknown which International Classification of Primary Care (ICPC) codes street doctors assign to this diverse patient population and how this has developed over time. Therefore, we have conducted research based on the following questions: