Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 25
The next major push for public health coverage came from the central
government as part of its wartime planning and post-war reconstruction efforts
(MacDougall, 2009). In the Dominion–Provincial Reconstruction Conference
of 1945–1946, the federal government put forward a broad package of social
security and fiscal changes, including an offer to cost-share 60% of the
provincial cost of universal health insurance. The offer was ultimately rejected
because of the concerns, mainly held by the Governments of Ontario and
Quebec, about the administrative and tax arrangements that would accompany
the comprehensive social security programme. The failure of this conference
forced a more piecemeal approach to the introduction of universal health
coverage in the post-war years.
In 1947, the Saskatchewan Government implemented a universal hospital
services plan popularly known as “hospitalization”. Unlike private insurance
policies, no limitation was placed on the number of “entitlement days” as long
as the hospital services rendered were medically necessary and no distinction
was made between basic services and optional extras. In addition to hospital
services, coverage included X-rays, laboratory services and some prescription
drugs used on an inpatient basis. These design features did much to eliminate
the possibility of a parallel tier of private hospital insurance. Saskatchewan was
financially aided by the federal government with the introduction of national
health grants in 1948 (Johnson, 2004b). In addition to providing money for
new hospital construction, these grants helped to fund provincial initiatives in
public health, mental health, venereal disease, tuberculosis and general health
surveys (Taylor, 1987).
In 1949, the Government of British Columbia implemented a universal
hospital insurance scheme based on the Saskatchewan model. One year later,
the Government of Alberta introduced its own hospitalization scheme through
subsidies paid to those municipalities that agreed to provide public hospital
coverage to residents. Both programmes encountered challenges. In British
Columbia, the difficulty of premium collection led to a revamping of the
programme after a new administration was elected in 1952 (Marchildon &
O’Byrne, 2009). In Alberta, the partial and voluntary nature of the initiative
meant that on the eve of the introduction of national hospitalization in 1957,
25% of the population still did not have hospital insurance (Marchildon, 2009).
In 1955, the Government of Ontario announced its willingness to implement
public coverage for hospital and diagnostic services if the federal government
would share the cost with the province. One year later, the federal government
agreed in principle to the proposal, and passed the Hospital Insurance and