Academic Literature on PID
No.	Author (Year)	Country	Approach/Method	Objective	Relevant Findings
1	Appel et al. (2004) [40]	USA	Qual/interviews with outreach staff (n = 55) and intravenous drug user (IDU) clients (n = 144)	Obstacles to AOD (alcohol & other drug) enrollment inherent in policies, practices, and attitudes of institutions	Lack of ID among top five barriers to enrollment and completion of drug abuse treatment program; client suggestions for program facilitators include “admit people who have no PID or documents”
2	Asanin et al. (2008) [34]	Canada	Qual/focus groups (n = 8) with 58 immigrants from diverse race/ethnic backgrounds	Explore immigrants’ perceptions of barriers to access to healthcare	Delay in receiving provincial health card results in either lack of healthcare access for several months or in paying for private health insurance, which is costly for many recent immigrants
3	Butters et al. (2003) [24]	Canada	Qual/interviews with female street-involved crack users (n = 30)	Examine healthcare needs and experiences women who were involved in the street life of crack and prostitution	ID a key factor affecting access to health care; to get a health card you need ID and an address (which homeless people do not have); 43% did not have a health card for reasons including never had one, lost, stolen, or destroyed
4	Campbell et al. (2015) [17]	Canada	Qual/interviews and focus groups with homeless individuals (n = 11) and healthcare providers (n = 11)	Explore perceived healthcare needs and barriers among individuals experiencing homelessness	Many providers and clients described that an important barrier to accessing healthcare services is lack of government-issued ID, including provincial healthcare card; missing/stolen ID cited as common problem
5	Cheng et al. (2016) [35]	USA	Quant/analysis of electronic database (n = 11,989)	Evaluate associations of missing paternal demographic information on birth certificates with perinatal risk factors for childhood obesity	Six percent were missing paternal data; missing paternal data on the birth certificate is associated with perinatal risk factors for childhood obesity
6	Christiani et al. (2008) [42]	USA	Qual/focus groups with homeless drug-using youth (n = 54)	Investigate barriers and facilitators in delivery of healthcare services from the perspectives of homeless youth	Structural barriers include agencies with multiple bureaucratic requirements involving interagency referrals, need for ID cards, onerous paperwork, and lack of continuity of care
7	Daiski (2005) [41]	Canadian	Qual/interviews and focus groups with client volunteers (n = 58)	Evaluate effectiveness of the Health Bus, a mobile healthcare unit	At one location, only half of the participants possessed a health card. Health cards and other ID often stolen or lost; the Health Bus was the only healthcare people without a health card accessed; another barrier is attitude of health care workers
8	Ensign et al. (2002) [28]	USA	Qual/interviews with homeless young women (n = 20)	Explore common sources of advice, health-seeking behaviors, and access to care issues of homeless adolescent women	Participants said that the biggest structural barriers to care at many hospitals or clinics not designed for homeless youth were questions over consent for care, being asked to provide addresses and an ID card, and source of insurance or payment
9	Gany et al. (2013) [44]	USA	Quant/assessment survey administered in-person to randomly selected food pantries (n = 47)	Analyze how well food pantries accommodate the service needs of medically ill clients	Twenty-nine food pantries (62%) had an identification requirement, including six (or 21%) requiring a government-issued photo ID; requirements for government-issued ID likely to discourage undocumented immigrants
10	Gordon (2012) [27]	Canada	Qual/interviews with 102 people visiting ID clinic established to provide basic ID card provided by municipality free of charge	Explore reasons that people lack ID, impact of no ID, and significance that new ID card has for them	Main reasons for ID loss: theft, carelessness, police interaction, drug/alcohol event; main impact of no ID: banking, healthcare, housing, alcohol/cigarette purchase, police checks, treaty benefits, driving, money mart usury; significance of new ID: member of community, access to services
11	Heyman (2009) [31]	USA	Mixed/survey of uninsured immigrants (n = 84); interviews with same (n = 52)	Determine healthcare-seeking paths by unauthorized migrants, barriers encountered, and resilience factor of learning and gaining confidence about available services	Participants reported increased demands for PID in order to get healthcare (e.g., employment history, social security number, and citizenship or legal residence ID. “Ernesto has never had these documents…but this documentation requirement is now a basis for denial of services that he previously received.” He remarked, “They [the hospital] are asking for things I cannot produce” (p. 11)
12	Hwang et al. (2000) [48]	Canada	Quant/document review of patient encounter and billing records (n = 45)	Document how frequent physicians are not paid for the care they provide to homeless people in outreach settings	Study finds high proportion of homeless people without valid health insurance cards; 46% of encounters with patients without a health card at all, though reasons not specified
13	Hwang et al. (2010) [18]	Canada	Quant/survey of homeless individuals (n = 1169)	Examine extent of unmet needs and barriers to accessing healthcare among homeless people within a universal health insurance system	Three hundred and fifteen participants were not in possession of their health insurance card; often it was lost or stolen
14	Khandor et al. (2011) [38]	Canada	Quant/survey of homeless adults (n = 385)	Examine active healthcare-seeking paths of unauthorized migrants, range of barriers that they encounter, and resilience factor of learning and gaining confidence about available services	One hundred and twenty-four (34%) participants were not in possession of a health card; most of the people without a health card reported that their card had been lost (48%) or stolen (18%)
15	Kurtz et al. (2005) [33]	USA	Mixed/surveys of street-based female sex workers (n = 586); focus groups with same (n = 25)	Assess health and social service needs and barriers to access among street-based women sex workers	Lack of legal ID, address, and/or citizenship status causes women to be ineligible for most employment. Lack of space for ID storage is also a problem, as sex workers are often robbed
16	LeBrón et al. (2018) [20]	USA	Theoretical/not stated	Describe three ways government-issued ID requirements have restricted access to health resources	An estimated 11% of voting-age US citizens lack ID, with certain communities additionally marginalized due to lacking a permanent address (e.g., people who are homeless or experienced catastrophic events like fire, domestic violence, environmental disaster)
17	McKeary et al. (2010) [47]	Canada	Qual/interviews with healthcare providers (n = 14)	Explore the systemic barriers to healthcare access experienced by refugee populations	Lack of insurance coverage also created a barrier to care (6.3%) six months after arrival, but this disappeared with access to a provincial health card granted after residency waiting period. Additional ID barriers include burdensome paperwork, unclear eligibility rules, poverty, isolation, lack of access to transportation, language, and illiteracy
18	Melnik et al. (2015) [36]	USA	Quant/survey of birth registrars (n = 127)	Better understand the current birth registration practices and barriers in accurate and complete reporting	Incomplete information provided by medical staff, birth data are located in multiple systems, conflicting birth data information from different sources, staff resources are inadequate, need for improvement of hospital electronic data systems
19	Pauly (2008) [64]	Canada	Theoretical/not stated	Examine harm reduction values and conceptions of justice as framework for addressing inequities in health and healthcare for street-involved drug users	Lack of ID is barrier for accessing health care services or gaining prescription coverage
20	Shelton (2015) [39]	USA	Qual/interviews with young people (n = 27)	Investigate the lived experiences of transgender and gender expansive young people with histories of homelessness	Some participants arrived at shelters lacking ID; without ID documents that match their self-designated gender and presentation, transgender and gender expansive young people face harassment and discrimination when applying for jobs. Lack of accurate ID increases likelihood they will experience misgendering during hiring process and while on the job, if hired. Frequent experiences of cisgenderism lead some to not seek employment
21	Smith et al. (2010) [37]	USA	Quant/comparison of health plan records with hospital birth certificate records of 325,810 children born between 1998–2008	Investigate validity of race and ethnic information in health plan administrative records and if this affects understanding of race/ethnic disparities in healthcare utilization	Birth certificates have more accurate data on parental status at time of birth and race/ethnicity; easier access to birth certificates for birth information will improve health access and health outcomes; inconsistent PID information presents difficulties later in life if people need to replace PID
22	Wilson (2009) [19]	USA	Mixed/interviews with staff (n = 10) and clients (n = 14) of prisoner re-entry program; document review; ethnographic observation	Examine range of help-seeking activities; identify dynamics that facilitate access to public services for recently incarcerated people re-entering society	Lack of ID is key barrier for returning offenders; ID often lost during arrest and incarceration or due to mental health challenges. Without ID it is difficult for offenders to apply for ID, a cycle that leads to delays in access to health and social services for people trying to re-enter society and get jobs
Gray Literature on PID
No.	Author (Year)	Country	Approach/Methods	Objective	Relevant Findings
23	Goldblatt et al. (2011) [45]	Canada	Qual/interviews with staff from social housing support organizations (n = 48)	Identify systematic barriers to housing experienced by service providers	Lack of ID is key barrier to accessing social housing and income support
24	Hussey (2015) [25]	USA	Not stated	Identify structural barriers that LGBT youth face in attaining ID and identify policy recommendations for overcoming barriers	Barriers include age restrictions, fees, lack of address, as well as unique barriers for certain communities (e.g., transgender youth, undocumented youth, system involved youth). Recommendations include: establish municipal ID programs that can be tailored to community needs; reduce or waive fees for ID; easing parental approval for ID for a minor, as many LGBTQ youths experience homelessness due to family rejection
25	Kopec et al. (2016) [50]	Canada	Qual/interviews with staff at four ID banks	Explore avenues available for creating an ID bank for homeless and vulnerable clients	Main barriers are funding and staffing, though once established, ID storage can be inexpensive
26	NLCHP (2004) [29]	USA	Quant/survey of service providers (n = 56) in 16 states that serve total of 25,647 clients per year	Assess nature and extent of the problems faced by homeless persons without photo ID	Around one-tenth (10.7%) of clients lacked photo ID; barriers include lack of address and high cost/fees; implications of not having ID include: denied access to benefits and services and problems with law enforcement
27	NNY (2016) [32]	USA	Not stated	Provide overview of issues related to minors obtaining an ID and related recommendations for policy makers	Four main barriers to obtaining ID: needing/obtaining birth certificate, age limits and parental consent, fees, and proof of residency
28	Shepherd et al. (2003) [49]	Canada	Not stated	Provide updated information on state of poverty, housing, and homelessness in Toronto	Homeless people at greater risk of having ID, such as their health card, stolen or lost; yet they are most vulnerable and likely to require healthcare
29	Shartal et al. (2004) [46]	Canada	Qual/interviews with homeless people with disability (n = 85)	Describe experiences of homeless people with disabilities unable to access Ontario Disability Support Program (ODSP)	Homeless people often do not possess ID and financial documents required to apply for the program; thus, ID is structural barrier for most marginalized people
30	The Street Health Report (2007) [43]	Canada	Quant/survey of homeless adults (n = 368)	To fill a gap in current knowledge about the health status of homeless people in Toronto	Six percent of respondents said lack of ID is reason for homelessness; ID lost or taken away by authorities; importance of ID for accessing social services
31	United Way (2013) [26]	Canada	Not stated	Not stated	Barriers include cost and need of address to get ID