Canada - World Health Organization Regional Office for Europe

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