Marcel Slockers

95 Effects of health insurance policy changes on access to care for homeless people Recommendations An increase in the number of uninsured homeless people has serious implications for the individual patient and requires extra efforts and costs for care providers. 9 In order to improve accessibility to basic medical care, we make the following recommendations: • We not only ask national and local administrators and all care workers for more under- standing of the human being behind the uninsured, but also for patience and talent in assisting homeless people to become reinsured. • The medical oath should be respected, both at the entrance of the hospital as in the GP’s practice. This means that the duty to take care of this target group comes first. • Dutch street doctors expect the Ministry of Health Welfare and Sports to come to a practical, simpler and faster policy with regard to health care insurance for homeless people without an address, in agreement with health insurance companies and munic- ipalities. • Vulnerable people without an address should have priority in getting health insurance with the aid of specially appointed workers of the GGD. The municipality should have confidence in these care workers and their capability in deciding who is entitled to health insurance. Even before all the formalities such as an ID, arrears in payments, address are properly arranged. • After detention, people without an address, have problems to become reinsured. During detention, The Ministry of Justice is responsible for medical care and the insurance is frozen. After release, the insurance will not automatically be unfrozen. Without an address, restarting the insurance is complicated. Assistance in getting an address is of vital importance for prisoners released. • In case of care avoidance or for patients with a confused mind we should introduce a so called IZS, a Dutch term for a special measure to speed up the process of reinsurance mandated by the Ministry and the mayor respectively, in order to finance psychiatric and somatic medical treatment. 10 The NSG insists on the possibility of immediately insuring entitled Dutch citizens for essential medical care on the advice of a physician. • There must be temporary financial arrangements for basic medical care for uninsured people without an address, compared to the arrangements for people who have no valid residence permit. • Following these recommendations, street doctors will be able to do what really matters: taking care of homeless people, people who have the lowest life expectancy in our society.