July 2, 1998

 To:Community and Neighbourhood Services Committee

 From:Jack Layton

Co-Chair, Advisory Committee on Homeless and Socially Isolated Persons

 Subject:Impact of Health Card Requirements on the Homeless

 Purpose:

 To increase access to health care by people who are homeless which is currently restricted by stringent health card requirements imposed by the Ministry of Health on March 1, 1998.

Recommendations:

 It is recommended that:

 1)Council request an urgent meeting with the Minister of Health, in conjunction with representatives of the Health Care for the Homeless Group, to discuss strategies for ensuring effective health care access for people who are homeless in light of the imposition of strict health card requirements by the Ministry of Health.

 Background/History:

 In January 1998, the Health Sub-Committee of the Advisory Committee on Homeless and Socially Isolated Persons brought together a diverse group of health care providers to discuss strategies for dealing with impending changes to Ontario's health care system which were expected to have a negative impact on people who are homeless. This Health Care for the Homeless Group included community health agencies, institutional health providers, municipal public health officials, provincial professional organizations representing nurses, physicians and hospitals.

 In February 1998, the group wrote to the Minister of Health outlining several concerns with the strict health card verification requirements and the elimination of "good faith payments" to physicians providing health care to people without health cards scheduled for implementation on March 1st, 1998 (attached is a copy of the letter). The group requested an urgent meeting with the Minister discuss these concerns and also to discuss viable strategies which they had developed to address these issues. At the same time, Toronto's Commissioner of Community and Neighbourhood Services sent a similar letter to the deputy minister.

 By early June neither the Health Care for Homeless Group nor the Commissioner had received a response from the Minister regarding their request for a meeting. The Health Care Group finally heard from Minister Witmer upon informing her of a scheduled press conference on the issue. The Ministers' response was to refer the group to the Health official responsible for co-ordinating a recently announced project to enhance health care services for the homeless through three Community Health Centres (CHC) in Toronto. While this initiative is considered to be a positive step, the dollars ($6,000,000.00 across the province) are insufficient to cover identification replacement costs let alone meet the primary health care needs of homeless people. This initiative is also limited as the funding is attached to Community Health Centres and not all homeless people use this type of health service.

 The Health Care for Homeless Group went ahead with the press conference on May 20, 1998 (attached is a copy of the press release). Minister Witmer still denies their request to meet.

 Discussion and/or Justification:

 Since March 1, 1998, the Ministry of Health has communicated the message that people must have a health card in hand in order to receive medical attention. Health care facilities across the province display posters which announce "All patients must show health card when checking in with receptionist" and "The most effective way to prevent fraud: carry your card."

 People who are homeless, who have mental illness or who are otherwise living in poverty are particularly vulnerable to health card loss or theft which now seriously jeopardizes their ability to access health care. These groups of people are also more likely to suffer ill health than the general population. Street health care workers provide accounts of people who are afraid or who think they cannot receive medical care unless they have their card in hand. Some people have been refused health care because they did not have a health card even though they were able to provide it verbally. These example illustrate the serious communication issues between the Ministry of Health, health care providers and the general public. When pressed, the Ministry contends that a health card number is all that is required but clearly this information is not being communicated in an effective way.

 There is also the ongoing issue of people who do not possess a health card at all. Street Health, a small community nursing agency, is one of the few agencies which help people to obtain the necessary original identification to get a health card. This is a costly service both in terms of dollars and staff time. The demand for this type of assistance has continued to increase. They regularly receive calls from hospitals in the Toronto area and as far as Hamilton and Oshawa asking them how to obtain health cards for patients. This illustrates the serious communication problems regarding health cards from the Ministry of Health to health care providers.

 Given the serious health care access issues for homeless people resulting from changes imposed by Ministry of Health, and the continued refusals of the Minister of Health to meet with the Health Care for the Homeless Group, the Advisory Committee on Homeless and Socially Isolated Persons urges Council to use their influence to convene such a meeting with Minister Witmer on this critical issue.

 Conclusions:

 The Ministry of Health wants people to show their health cards to receive health care and yet make it increasingly difficult to obtain a card. In addition, the Ministry has not clearly communicated the health card requirements to health care providers or to the community which is creating serious barriers for people in getting medical attention. Homeless people are particularly vulnerable to health card loss or theft thus threatening their ability to access health care under the new requirements. The Health Care for Homeless Group represents a diverse group of key health care providers with viable proposals for addressing health card access issues. Support from Toronto City Council to convene meeting between the Health Care Group and the Minister of Health represents a significant step toward increasing access to health care for homeless people in Toronto.

Jack Layton, Co-ChairAlison Kemper, Co-Chair

Advisory Committee on Advisory Committee on

Homeless & Socially Isolated PersonsHomeless & Socially Isolated Persons