The Blackwell Companion to Medical Sociology

200 B. Singh Bolaria and Harley D. Dickinson
ements, regionalized forms of health policy planning and service delivery, community
clinics, as well as various hospital and medical care insurance plans (Douglas
1946; Mott 1947; Roth and Defries 1958; Wolfe 1964; Mombourquette 1991).
Health care insurance was an issue that was variously on and off the national
and provincial political agendas. By the 1940s, failure of the market to ensure
adequate access to necessary medical and hospital care, combined with limitations
of the various locally developed collectivist solutions, had generated
renewed interest in state medical care and hospitalization insurance. This was
given added impetus by experiences with war time military and industrial
recruitment where it was discovered that an alarmingproportion of recruits
were too sickly for military or industrial service (Fuller 1998: 27). As a result of
this experience, and other statistics that demonstrated the poor health status of
the Canadian population, health insurance was firmly established as a key
component in government plans for postwar reconstruction.
Thus, in 1945, the Federal government put forward a plan for a universal
health care insurance program cost shared by the federal and provincial governments.
The general rationale for state intervention in this area was the belief that
improved access to hospital and physician services would result in improved
health status. This in turn was seen to translate directly into increased productivity
and national prosperity. A more particular motivation for proposinga
state financed, universal, and comprehensive health insurance program was
concern that the proposed alternatives were inadequate.
By the end of the war there was a political consensus that health care could not
be left to the market. Beyond that, however, there was little agreement. The
medical profession favored a hospital and medical care insurance system that
was based on voluntary participation in physician-sponsored or commercial
insurance plans. The state's role would be limited to providingcoverage on a
means-tested basis to the medically indigent. The private insurance industry was
in favor of a similar arrangement. Business organizations in general also
favoured such an arrangement because of concerns about creeping socialism,
as were several provincial governments. Even the organized trade-union movement
was somewhat ambivalent about universal, compulsory state health insurance
because they had largely secured coverage for their membership through
various voluntary, private plans (Walters 1982). Amongthe strongest supporters
of state insurance were the various farmer organizations, especially in western
Canada. It is not surprisingthen that the first compulsory, universal, state
financed and administered hospitalization insurance plan was introduced in
Saskatchewan by a newly elected political party dominated by farmer interests
(Dickinson 1993).
The federal government was convinced of the necessity to introduce a similar
plan on a national scale for the reasons cited above. Thus, in 1945, at the
Federal-Provincial Conference on Reconstruction, it introduced draft legislation.
Key features of the legislation were the establishment of health regions, patient
registration with physicians, a capitation mode of payment, additional financial
incentives for physicians who adopted preventative approaches, and the administration
of the system by commissions consistingof both physicians and consumers
(Taylor 1978; Vayda and Deber 1992: 126).