Impact of Health Card Requirements on the Homeless
The Community and Neighbourhood Services Committee recommends the adoption of the following report (July 2,
1998) from Councillor Jack Layton and Ms. Alison Kemper, Co-Chairs, Advisory Committee on Homeless and
Socially Isolated Persons:
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.
Recommendation:
It is recommended that 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, and 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 1, 1998 (attached is a copy of the letter). The group requested
an urgent meeting with the Minister to 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 1998, neither the Health Care for the Homeless Group nor the Commissioner had received a response from
the Minister regarding their request for a meeting. The Health Care for the Homeless Group finally heard from Minister
Witmer upon informing her of a scheduled press conference on the issue. The Minister's 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 (CHCs) 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 the 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 examples
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 the 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 a meeting between the
Health Care for the Homeless Group and the Minister of Health represents a significant step toward increasing access to
health care for homeless people in Toronto.
(A copy of the communication and press release referred to in the foregoing report was forwarded to all Members of
Council with the agenda of the Community and Neighbourhood Services Committee for its meeting on July 16, 1998, and a
copy thereof is on file in the office of the CityClerk.)