Marcel Slockers

93 Effects of health insurance policy changes on access to care for homeless people Table 1. Factors contributing to homeless people being uninsured* Characteristics of homeless people Mistrust in institutions and health care Substance abuse, psychiatric problems, mistrust Intellectually disabled, poor reading and writing abilities Not being able to read the time, and to keep appointments Inadequate money management, getting into debts Late payments of health insurance, reminders, fines Lack of understanding rules and regulations, forms and DigiD (a kind of digital passport system for Dutch government organisations to identify someone’s identity) Refusing to cooperate in certain procedures Laws and regulations Compulsary carrying of a valid ID Compulsary having an (mailing) address Mandatory registration BRP (official register in The Netherlands of all people living in the country) Mandatory registration with a health insurance company An income for paying health insurance premiums Rules and regulations for access to shelter and care services Local connection to council/region # Proof of homelessness during a certain length of time Registration Central Homeless Coordination Desk Shelter card for admission to night shelter Obligation to use night shelter for a certain amount of time Compulsory cooperation in a recovery program Social services and care Civil servants’ and social workers’ unfamiliarity with rules and procedures Civil servants’ and social workers’ attitudes Case managers’ and social workers’ lack of decisiveness An overview of all debts (BKR, a Dutch Credit registration office) and who is going to deal with what debt Fines CIJB (a Dutch governmental office for traffic fines) and no possibility of remittance Slow procedures in municipalities, social services, insurers To reinsure with an insurance company, a proof of release from detention is required Delay in processing data about insurance status in VeCoZo (Dutch abbreviation for a secure communication system in healthcare) * According to the answers of 29 professionals on a questionnaire in January 2016 from 13 towns/regions (Amsterdam, Bergen op Zoom, Breda, Den Bosch, Flevoland, Groningen, Haarlem, Nijmegen, Oss, Rotterdam, Tilburg, Utrecht and Zwolle). # The Netherlands have 42 municipalities/towns with government assistance for social care services, for people who became homeless in one of those 42 towns or surrounding municipalities (local connection).