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No health card means no family doctor for many homeless people

Toronto, May 24, 2011

For every year a person is homeless, the odds of them having a family doctor drop by 9 per cent, according to a report by St. Michael’s Hospital and Street Health.

One of the key barriers to having a family doctor is the lack of a health card, often because it has been lost or stolen, the report found.

The report, published today in the journal Open Medicine, is an analysis of data collected for The Street Health Report 2007, a survey of the health status and needs of homeless people in downtown Toronto. That report found that only 43 per cent of homeless people have a family doctor, compared to 88 per cent for the overall Toronto population.

The primary authors of the article are Erika Khandor and Kate Mason, who were both research coordinators at Street Health at the time of the study. Khandor now is an epidemiologist with Toronto Public Health and Mason is a research coordinator at the Centre for Research on Inner City Health (CRICH) of St. Michael’s Hospital.

“We know that access to primary care through a family physician is important for everyone’s health,” said Dr. Stephen Hwang, a physician-researcher at CRICH. “It’s even more important for people who are homeless and ill and who may end up using emergency rooms and hospitals if they don’t receive good primary care.”

The analysis found homeless people were more likely to have a family doctor if they were gay, lesbian, bisexual or transgender; possessed a health card; or had a chronic medical condition such as diabetes, HIV/AIDS or high blood pressure.

It found that 34 per cent of homeless people did not have a health card, which serves as proof of health insurance in Ontario. Of those, almost half (48 per cent) said they had lost their cards and 18 per cent said the cards had been stolen.

“Our findings point to the ongoing need to help secure and maintain health cards for homeless people, for example by offering programs at homeless service agencies to assist with the replacement and storage of health cards and other forms of identification such as birth certificates and driver’s licenses,” the report said.

“Additional mechanisms to improve access to primary care in this population include increasing the provision of drop-in clinics and community health centres that use alternative physicians billing systems and do not require patients to present their health card.”

Street Health was the first agency in Canada, and remains the only one in Toronto, to offer secure document storage for about 550 homeless people. Its ID Safe program both stores documents such as health cards, passports and driver’s licenses in a fireproof filing cabinet and provides a mailing address and other assistance for homeless people trying to replace lost or stolen documents.

The Coordinated Access to Care for the Homeless (CATCH) program was also created last September to help homeless people who have unmet complex health care needs to access health resources in the community. The program, which is a partnership between St. Michael’s Hospital physicians, Toronto North Support Services and Toronto Central Community Care Access Centre, has connected more than 160 people to health care.

Dr. Hwang and Laura Cowan, executive-director of the Street Health Community Nursing Foundation, made substantial contributions to the conception, design and analysis of this study. Catharine Chambers, a research coordinator at CRICH contributed to the data analysis, interpretation and drafting of this article. Kate Rossiter,an assistant professor in Health Studies at Wilfred Laurier University in Waterloo also contributed to this article.

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