Minister Dubé recently declared that 13,000 so-called “vulnerable” people were registered on the waiting lists for the Family Doctor Access Center (GAMF). While some members of the medical profession perceive this statement as an attempt to place responsibility for this number on them, others question this statement outright.
However, this number actually represents only a fraction of the people requiring rapid support, because it does not include thousands of people living in a homeless situation across Quebec.1.
GAMF access criteria: where the problem lies
The eligibility criteria for the GAMF seem more than simple: it essentially involves having a health insurance card. However, registering for these waiting lists requires a seemingly innocuous element, but which is far from it: having a postal code.
As demonstrated by the most recent 2022 count of people experiencing homelessness2, more than 10,000 people are experiencing visible homelessness in Quebec, an increase of 44% since that carried out in 2018 (a conservative number since it does not include hidden homelessness). Very few of them have a postal code or still reside at the address on their file. A limited number of these people can be enrolled through creative measures by healthcare workers and community settings working with these people.
In my experience, however, the registration and prioritization of homeless people at the GAMF remains highly problematic, among other things because of the lack of response from the Régie de l’assurance santé (RAMQ) on this issue.
Already in 2018, the Public Protector revealed the flaws of the GAMF and recommended that the files better reflect the state of health of the registered people, without addressing the very barriers to registration3. Across Quebec, stakeholders in the health network are constantly fighting against the rigid structures of the GAMF to register these people and assert their right to obtain care within acceptable time frames.
Some solutions exist
Beyond this accounting and political debate lies a disturbing reality of increased vulnerability and marginalization of the province’s most vulnerable citizens. Due to a restrictive administrative criterion (the obligation to have a postal code), thousands of vulnerable people simply do not have access to the GAMF.
If the government relies on the GAMF as a necessary point of access to family doctors, it has an obligation to ensure the consistency of this tool to adequately serve the most vulnerable members of the population.
The RAMQ must therefore take on this urgent matter, abolish the need to present a postal code and deploy a platform that allows the registration of people living in a homeless situation according to their geographic preference to receive care.
On the other hand, those responsible within the RAMQ must identify themselves and be able to respond promptly to requests from stakeholders for the management of exceptional cases. In doing so, we could ensure truly equitable access to front-line health care through the GAMF.
1. Read “13,000 vulnerable patients, a number that “means nothing””
2. Consult the technical sheet “Counting people experiencing visible homelessness in Quebec”
3. Consult the report “Improving the registration process with a family doctor”
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reference: www.lapresse.ca