Are institutional health policies exclusionary?

I examined the experiences of 27 individuals who frequented a homeless shelter in Toronto, Canada. Participants' personal accounts led to cumulative understandings of the exclusionary practices that are often perpetuated by institutional organizations. Many individuals perceived themselves as "pushed out" or excluded by the structures of health care services that purported to support and serve them. However, individuals were also perceived as active agents in a complex, mutual form of exclusion, referred to as "mutually established exclusion," in which they chose to drop out or remove themselves from institutional mainstream services. Individuals who had chosen not to seek reissuance of their health cards either implicitly or explicitly self-excluded from participation in services that might be seen to regulate, control, and thereby subordinate their interests to those of the dominant institution. I ask, How are institutional health policies evidenced in the everyday, material lives of people? Are such policies exclusionary?