A Word About B.C. and Saskatchewan
The B.C. Health Insurance Proposal of 1935;
- original proposal called for compulsory coverage of those with dependent earning less than $200 per month and those without dependents who earned less than $ 100 per month
- Higher income groups could apply for voluntary coverage
- Medical association suggested that the $ 200 ceiling for compulsory coverage was too high and should be lowered to $ 125.
- This would have reduced the % of the population covered from over 85 to around 70.
- At the 80 % level doctors would have lost their best paying patients
- payment was to be by capitation
- contributions were as follows: employers - 2 %of their payrolls; employee - 3 % of weekly earnings; remainder from government
- subsequent amendments saw the employer and employer proportions lowered and most of the concerns of the medical profession over method of payment, fee schedules and coverage addressed
- the legislation was supported by low income employees, unions, women's and church groups, left -wing Liberals and the CCF ; opposed by businessmen and professionals, boards of trade and chambers of commerce, and property-owning rate-payers, and the BCMA
- legislation passed and was given Royal Assent in 1936
- a plebiscite in the 1937 election confirmed public support for the legislation, but the medical profession remained opposed.
- Liberals lost four seats, Minister of Health narrowly escaped loosing his seat.
- with economic recovery underway in B C_ the government quietly removed health insurance from the agenda
Saskatchewan:
- Municipal Hospital Plans:
- Rural Municipalities Act (1909) - allowed municipalities to pass bylaws to grant "aid or relief to any needy person who is a resident of the municipality."
-Union Hospital Act (1916) - allowed towns, villages and rural municipalities in Union Hospital Districts to establish local authorities for the purpose of erecting and maintaining hospitals. By 1947, these Districts covered over one third of the settled area and one third of the population. (about three-eighths of the province's hospital beds)
-Rural Municipality Act - amended in 1916 to allow rural municipalities to contract a physician on retainer up to $1500/year to provide medical services for residents (in response to the threatened loss of a physician in the rural municipality of Sarnia in 1914). Scheme was emulated by Alberta and Manitoba.
-Rural Municipality Act - amended in 1934 to allow municipalities to fix an annual tax for non-rate-payers.
-Municipal Medical and Hospital Services Act (1939) - allowed a municipality of group of rural municipalities, towns or villages to provide medical and hospital services by either levying a land or personal tax or a combination of the two, not to exceed $50 per family.
- Hospital Insurance (1944) - called for the appointment of a commission to administer a government health insurance program
-content would depend on the outcome of federal discussions
- Hospital Insurance Act 1947 - universal, compulsory insurance; financed through a municipal levy; low-income or otherwise subsidized individuals would be paid for through the applicable funding agency to a maximum of $30/year/family or $ 5/year/individuals, plus subsidization from general tax revenues; range of hospital services; administered by a government commission
-resulted in dramatic utilization increases and thus costs
- served as the prototype for other provincial and nation hospital insurance legislation.
- Health Regions - Swift Current Health Region established in 1946 after a local plebiscite.
- a 12 member district health board elected from among municipal councilors serving a mainly rural population of about 50,000 based on the City of Swift Current (6400).
- involved 19 physicians (35 by 1950)
- paid through a combination of premiums and property taxes, and a 105 subsidy
- patients free to choose doctors and doctors paid on fee-per-service basis
-fee schedule negotiated with the region by the local medical society provincial association didn't like this)
-a second district established in 1947
- attempts to expand the number of Districts in the early I 950s were successfully repelled by the medical profession.
- Medical Insurance - universal, tax-supported medical insurance; administered by a public authority; physicians could bill through a variety of mechanisms including existing physician-sponsored plans
- a major doctor's strike was ended by softening the government position on administration of the plan and payment of physicians
-served as the prototype for national health insurance legislation