Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
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24<br />
<strong>Health</strong> systems in transition <strong>Canada</strong><br />
While most provinces followed Ontario’s lead in terms of targeted or<br />
categorical public health services and coverage, the provinces in western<br />
<strong>Canada</strong> laid the groundwork <strong>for</strong> the universal hospital and medical care<br />
coverage that would eventually become known as medicare. In 1916, the<br />
Government of Saskatchewan amended its municipal legislation to facilitate<br />
the establishment of hospital districts, as well as the employment of salaried<br />
doctors providing a range of health services including general medical and<br />
maternity services, and minor surgery. These hospitals and physicians served<br />
all residents of participating municipalities on the same terms and conditions<br />
(Taylor, 1987; Houston, 2002).<br />
During the 1920s, the Government of Alberta responded to the pressure <strong>for</strong><br />
state health insurance by establishing a commission to examine a range of policy<br />
options. The report of the Legislative Commission on Medical and Hospital<br />
Services was delivered in 1929. While this report, as well as a subsequent study,<br />
concluded that state health insurance – whether administered by the provincial<br />
government or the municipalities – was feasible, the Government of Alberta<br />
concluded that the cost to the public treasury was too high given the onset of the<br />
Great Depression of the 1930s, and delayed implementation until after <strong>World</strong><br />
War II (Lampard, 2009).<br />
In 1929, the Government of British Columbia appointed a Royal<br />
Commission on State <strong>Health</strong> Insurance and Medical Benefits. Delivered in<br />
1932, the commission’s report recommended a social health insurance scheme,<br />
with compulsory contributions <strong>for</strong> all employees below a threshold level of<br />
income. Although a law was passed in 1936, the scheme’s implementation was<br />
postponed, and then ultimately abandoned, when the government failed to<br />
secure the cooperation of organized medicine in the province (Naylor, 1986).<br />
As a result of the Great Depression, a growing number of Canadians were<br />
unable to pay <strong>for</strong> hospital or physician services. At the same time, government<br />
revenues fell so rapidly that it became more difficult <strong>for</strong> the provinces to<br />
consider underwriting the cost of health services. Despite this, Newfoundland<br />
introduced a state-operated cottage hospital and medical care programme to<br />
serve some of the isolated “outport” fishing communities in 1934, 15 years<br />
be<strong>for</strong>e it joined the Canadian federation. By the time Newfoundland (since<br />
renamed Newfoundland and Labrador) had become a province in 1949, 47%<br />
of the population was covered under the cottage hospital programme (Taylor,<br />
1987; Lawson & Noseworthy, 2009).