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