Monday, 17 August 2015

Saskatchewan's Health Care Evolution Towards Medicare Part I

Saskatchewan's Health Care Evolution Towards Medicare

Part I
Saskatchewan's Health Care Evolution Towards Medicare

Much has been written about Medicare, its birth in Saskatchewan, and the key players involved in its evolution. The following is a brief backgrounder, a reference to identify the evolution of health care in Saskatchewan. By examining the origins of medicare, and the actions of some of the more prominent people involved it is hoped that readers will remember the growth and evolution of medicare and what forces came into play during the history of health care. We invite readers to Phone or email Marilyn Decker , - - granddaughter of Matthew (Matthias) Anderson if you have observations, comments or suggestions you could share. It would be much appreicated if you could fill out a short Survey answering questions like: What are your memories of the doctor's strike in 1962? Were you working in the medical field at the time? What are your memories of life before medicare?

Pioneer Saddle Bag Doctor

" Medical care was practically non-existant in the very early times. Doctors and medicines were scarce and there weren't any hospitals. Home remedies were used and although perhaps good to a certain extent, there were many untimely deaths, especially from communicable diseases such as diptheria, small pox, typhoid and scarlet fever and consumption (T.B.)"Grummett p 17 "Resourcefulness in cases of emergency was fostered in the home of the pioneer on the western plains and home remedies had to be relied upon. Some of the favoured remedies were said to be, by those who spoke from experience, none too pleasant to the palate, but they had great healing power."Storer p. 104

"Doctor's those days had to be entirely dedicated to survive - that is, on the prairies. Often saw him in the dead of winter, in his voluminous coon coat, bundled into his cutter, out to serve humanity in the bleak outlands; rain, shine or blizzard." Greenblat p.19The prairie weather set obstacles for both rural resident and pioneering prairie doctors. "The roads were few and poorly maintained. When it rained, the mud was deep and sticky, often clogging the wheels of the buggy...The winter was the most trying time, especially when blizzards would blow up and continue for a day or two or more. The road would blow over with snow and only here and there could one see the track that had been made. When telephones came in, one would try to see from one pole to the other. If snow got deep on the road, it would be difficult to pass a cutter or sleigh coming from the opposite direction lest you slid off the road and find it very hard to get it back on. During those early days and for many years later, outbreaks of typhoid were very common. ...It was hard to get about in the winter and as telephonic communication was bad or nil, when one got a call to see a serious case, it would be arranged when the next visit was to be made."MacLean p.63

Much is said about the pioneer doctor travels: "Her practice required frequent travelling. For difficult trails or a distance that meant camping and the tending of horses, she always had a driver. On the Reserve, or to settler' homes within a range of ten to twelve miles, she drove Malin; and the doctor and her beautiful pacing mare became known throught the country."Buck p. xvi

The British North America Act of 1867, Sec. 92 set out that the local public health activities should be established and maintained by institutions set up by Provincial Governments. Provisions were set out for medical inspection of school children by medical health officers or public health nurses.StasCan 1939 p. 1027

Typhus fever, diptheria, typhoid, scarlet fever, the Spanish Flue influenza epidemic of 1916, venereal disease (vd), tuberculosis -(consumption)-, polio, accompanied the accidents, gangrene, blizzards, frostbite, broken bones, infections, food poisoning trials and tribulations of the early settlers. To quell the outbreak of contagious disease, Maurice MacDonald Seymour implemented a highly publicized public health campaign, "The Seymour Plan" encouraging cleanliness, and sanitation. Seymour organized the Saskatchewan Medical Association (SMA) in 1905. Between 1885 and 1905, he served with the North-West Territories Medical Council, as either both president and vice-president.

According to Dr. Hugh McLean who practised medicine 1906-1912 a doctor could expect one dollar for an office call, two dollars for a house visit, and fifteen dollars for a confinement case. Additionally a dollar a mile may be added to the bill. In another report, before Medicare, "doctors make house calls and charge $4 to $7 for one. An office visit costs $5 or less. An appendectomy is $125. Removal of a tumour by a neurosurgeon is $350. Complete obstetric service- pre-natal, delivery and post-natal care - $80 for a general practitioner, $100 for a specialist."Cannel July 14, 1962

"In 1909, The Public Health Act created a Bureau of Public Health responsible to the Minister of Municipal Affairs. The Bureau played a largely supervisory role and was replaced by a more powerful Department of Public Health in 1923."Mombourquette. P. 101


A typhoid epidemic struck Medicine Hat in 1888. The Canadian Pacific Railway rallied around its divisional point. A Territorial bill was passed, and fund raising began for a hospital to support the town, the railway workers away from home. By 1890 a facility was raised. By 1910, the voluntary general hospital development days were over, municipalities worked in concert with the provincial government to establish hospitals.Feather

"When the province joined confederation in 1905, there were already voluntary organisations playing a service delivery function. For example, the Victorian Order of Nurses was providing homecare and running hospitals, the Salvation Army was aiding immigrants to settle in the prairies, and find jobs, the Canadian Red Cross was running hospitals, the Women's Christian Temperance Union was providing services to needy people, Yorkton Queen Victoria Hospital was providing inpatient services and the Regina Council of Women was instrumental in establishing other voluntary organizations to provide human services (e.g. Regina Children's Aid Society, Regina YWCA)."DeSantis p. 11 Dr. M. Seymour, as Commissioner of Public Health, he is appointed the first Medical Health Officer (MHO) for Saskatchewan.

Hospitals began in homes, with local nurses or doctors presiding over health care for early communities. On the arrival of the North West Mounted Police, sick bays and police surgeons began to be established at their posts. Alongside early fur trading posts and NWMP posts came missions run by protestant missionaries, Sisters of Charity (Grey Nuns), and Missionary Oblates of Mary Immaculate in Canada. Missionaries would set about establishing schools, dispensaries and hospitals. The Red Cross and Victoria Order of Nurses (VON) were involved with establishing the first hospitals. The 1885 North West Rebellion set up temporary military hospitals at local hospitals or town homes. The Union Hospital Organization was set into place facilitating the construction, and maintenance of hospitals by two or more municipalities. Further, these municipalities which formed the hospital district could enter into an agreement to provide free hospital treatment for certain classes of patients at the cost of the RM.sup>StatsCan 1939 p. 1034

From the late 1800s to about 1950, women in labour could turn to a midwife, a maternity home matron or a doctor for help in delivering a new arrival. Due to vast distances and poor roads and transport by horse and cart or ox and buggy, there was a strong demand for mid wives. Births may be attended to in the home, at a maternity home in the nearby town or village or in a hospital if a city was close by. The fees for the rural doctors (if one was available) were high. Maternity homes sprang up around the province, increasing in number until 1944. "The Mutual Medical and Hospital Benefit Act of 1944 precipitated a hospital building spree."Fung p. 63

Municipal Doctor System

"It was in 1914 that the residents of the village of Holdfast and the surrounding Rural Municipality of Sarnia No. 221 learned that their doctor intended to seek a more financially rewarding locality in which to practice. The news caused such widespread dismay that the municipal council took prompt and drastic but effective steps. A sum of $1500 from property tax revenue was offered as a retainer and Dr. H. J. Schmitt was persuaded to remain in Holdfast."Reid p.7

Manitoba spearheaded the program of "Mother's Allowances" in 1916 to provide assistance to mothers widowed or without any other means of support.CYB 1931 p. 1018 This program spread to other provinces.

The Rural Municipality Act of 1916 was amended to allow municipal doctor arrangements. The Health Services Board was established in the province to oversee these fee for service contracts. Gordon S. Lawson writes of the municipal doctor system which saw the introduction of Medical Services Incorporated MSI schemes in 1955. MSI allowed the patient to choose physicians anywhere in the province, and with better highway and vehicular transportation, rural residents wished access to specialist services available in the urban cities and towns which was not provided for under the municipal doctor plans.

Health Insurance Districts

in 1902, Anderson arrived and set up homesteading near Bulyea. In 1919, he returned to Norway, and "had the opportunity to gather information in regard to social services, particularly health services. I began to wonder why we couldn't adopt a similar plan in Canada with adjustments suitable to our conditions."Anderson p. 43

The Public Health Act was amended in March 1923 wherein the Bureau of Public Health was made a Department of Public Health under a Minister and Deputy Minister appointed by the government. This Department administered the Public Health Act, Vital Statistics Act, Union Hospital Act, an Act to Regulate Public Aid to Hospitals, Venereal Disease Act and the Tuberculosis Sanatoria and Hospitals Act.StatsCan 1927-1928 p. 963-964

As of 1926, Statistics Canada reported that there were 58 general, maternity, and isolation hospitals in the province, two sanitoria for consumptives, 2 hospitals for the insane and 1 home for orphan and refuges. The total number of patients treated at the 58 hospitals were 42,614, staffed by 883 doctors and 254,090 nurses and support staff.StatsCan 1927-28 p. 963-964

In 1927, Matthew S Anderson, Councillor of the Rural Municipality (RM) of McKillop 220 attended the Saskatchewan Association of Rural Municipality (SARM) Convention and proposed a health insurance plan based on the model from his home country - Norway. However SARM delegates could not see the feasibility of the proposal with the taxation scheme afforded to the RMs of that era. These localities were served by thirteen doctors; Holdfast (Rural Municipality of Sarnia No 221), Craik (RM of Craik No. 222 ), Beechy (RM of Victory No 226 ), Bethune (RM of DufferinNo No 190), Birsay (RM Of Coteau No 255), Brock (RM of Kindersley No 290 ), Chamberlain (RM of Sarnia No. 221), Freemont (RM of Hillsdale No. 440), Leroy (RM Of LeRoy No 339), Lintlaw (RM of Hazel Dell No. 335), Rush Lake (RM Of Excelsior No 16), and Senlac (RM of Senlac No. 411.).Houston and Massie. P. 28

Dirty Thirties

Drought and the economic depression years hit the prairies hard in the 1930s. It was a difficult time, medical institutions and health care practitioners were facing hard times, salaries could not be met, and renovations and improvements were forsaken. Settlers did not have money, crops failed, grasshoppers took whatever crop survived the heat and the early frost took the rest. The tremendous heat wave took an unprecedented number of lives. The huge dust storms caused dust Pneumonia, a respiratory disease affecting everyone across the plains. Russian thistle, (tumbleweed) was pretty much the only plant which grew during this decade. Not only people were short of food, but livestock were starving. The local doctor was lucky to earn $27 a month.

Beginning in 1931, special grants were provided by the provincial Relief Medical Services Branch to physicians and hospitals to allow them to proffer services to residents unable to pay for health care. The Bureau of Labour, and Public Welfare and Northern Settlers Branch of the Department of Municipal Affairs receive medical advice from the Relief Medical Services Branch.CYB 1939 p. 1035 'Northern Settlers' were those single transients and transient families who transferred to the northern area of the province seeking better conditions away from the drought area in the southern section of the province.CYB 1941 p. 908In 1931, C. Rufus Rorem reported thirty two municipalities with doctors working under the municipal doctor plan."Twenty had twenty-one full time doctors; twelve other municipalities had part-time agreements with sixteen physicians"

In 1938, the provincial government under Premier William John Patterson, proposed that Anderson set out the health service insurance plan for his RM. Anderson had been reeve since 1930 and a councillor since 1922 and worked towards his goal of Providing a cooperative health system - during the dirty thirties, the finances of the community was desperate, and few to none could afford any health care at all. "The initial tax was $5 per person up to a maximum of $50 per family. The population covered was 2,350."Anderson p. 64 The RM of McKillop, town of Strasbourg, and the two villages of Bulyea and Silton were covered becoming "Health District No. 1"

Municipal and Medical Hospital Services Act or the "Matt Anderson Act"

Matt Anderson in the Rural Municipality of McKillop No 220 instigated the passing of the Municipal and Medical Hospital Services Act (the "Matt Anderson Act") in November 1938 which allowed any group larger than ten persons to incorporate a health insurance plan. From this statute, RMs could supply hospital and medical services to the rural community by levying either a land tax or a personal tax. After this act was passed The RM of Strasbourg and Silton (RM Pittville No, 169) also followed the RM of McKillop No. 220 passing a similar bylaw to take advantage of the new legislation that same year. Anderson travelled to other regions introducing the concept. RM of Caledonia No 99, RM Of Chester No 125, RM of Lajord No 128, RM of Lumsden No 189, RM of Longlaketon No 219 established municipal medical plans by 1941. The RM of Webb No 138 followed by 1943.

The new health care plan met with favourable press, and incited keen interest across the province. The main alteration in health care was that doctors submitted their bills to the municipality rather than to each individual patient. In this way physicians were paid monthly. In 1938, Dr. R. G. Ferguson tallied 546 provincial doctors, of which 121 were under some sort of municipal contract.Houston and Massie p. 33

Commercial insurance companies sprang up providing support for the residents of Saskatchewan in the face of unpredictable medical and hospital care.Taylor p3-4 Doctor sponsored schemes such as Medical Services Incorporated, Saskatoon Medical and Hospital Benefit Association, Regina Mutual Medical Benefit Association, Group Medical Services, were some of the agencies which arose to meet the health care needs in urban and rural areas. These proved invaluable to the residents of Saskatchewan following World War II when the province began restructuring after the war effort and veterans returned home.

In 1941, the Dr. John J. Collins questionnaire received this reply from one of the rural doctors; "Any system is to be preferred to the present. Collections appear hopeless. I do not know how medical men can hope to carry on out here [all year] under present and future conditions."Houston and Massie p. 33

Health Services Board Inquiries

Over 1939 and 1940 Statistics Canada reported that the "Health Services inquiring into the extent and administration of the various health services existing in the province, collecting and studying data on the general situation regarding incidence of illness from all causes, considering methods for an equitable distribution of the costs of illness, studying the needs of the people with respect to general health services, and the necessity of co-ordination of those now existing."CYB 1939 p. 1035

The Saskatchewan Health Services Planning Commission was implemented In 1946, with Dr. Cecil G. Sheps as Acting Chairman, and Dr. Mindel G. Sheps, leader of the commission. Dr. Fred Mott was the chair for the Commission, and he also headed up the "Saskatchewan Health Survey Report" began in 1947 and completed in 1951. Dr. Len Rosenfeld served as Mott's deputy. The Hospital Insurance Act -Saskatchewan Hospital Services Plan (SHSP)- came into effect on January 1, of 1947 which provided Saskatchewan residents with free hospital care in the province. It wouldn't be until November 17, 1961 when the Saskatchewan Medical Care Insurance Act was passed, and the dream of Medicare in the province.

Swift Current Health Region No. 1 - pilot project.

The Secretary treasurer, W.J. Burak, in the RM of Pittville travelled to Bulyea to meet with the secretary to gather information to take back to Swift Current. "What many new comers may not know is that Swift Current and the region surrounding had the pilot plan for the whole scheme, inaugurated in 1946; thus pioneered the whole business. We had a plebiscite and it carried. Plebiscites in other regions of Saskatchewan lost."Greenblat 30

Just as Anderson had done in the area of Bulyea, so too did Burak in the Swift Current Health Region also reach out to settlers in the south western area of the province with success. It was thus that Swift Current Health Region No. 1 was born.

Swift Current Health Region No. 1 and Weyburn Health Region No. 3 offered a complete medical care plan including diagnostic, out patient services, general practitioner and specialist services in addition to the Hospital Services Plan. Swift Current Health Region was chosen as a pilot project due to the financial straits of the settlers, and the fact that there was a distinct lack of doctors practising in the area. The land in this corner of the province had started out in the late 1800s and early 1900s as ranch land -pastures and ranges- in the south western portion of the province, and was converting to agricultural mixed farming with a corresponding rise in the population.

[The Swift Current Plan before Medicare] -For a maximum of $96 per year, paid out of personal and land taxes, even the largest Swift Current region family is totally covered for every medical necessity, from sore throat to hospital stay. There is also a small "utilization fee" to discourage needless medical visits - $1 for office calls, $2 for house calls, $3 for medical service late at night or on Sundays."Cannel Aug 2, 1962.

For 14 years. Swift Current and area residents enjoyed the successful pilot program, physicians "submits his bill for services rendered to the health office in Swift Current which pays him 80 per cent of the fee. ...He makes out better by settling for 80 per cent and frequently comes out with a yearly income of #25,000. 'That is some $7,000 more than the average Saskatchewan doctor elsewhere earns.' "Cannel July 14, 1962.

Go to Part II


It is quite natural that Canadians used to medicare are bringing up the controversy regarding the United States Obamacare program in their conversations. This is an interesting time, observing the reactions, positive or negative that Americans are having with these new insurance policies. We, as Canadians may indeed be wondering how anyone could be against it.

However, in Canada when medicare was introduced, there was in fact, a 23 day strike against Canadian medicare that made international headlines. In contemporary times, few remember the inauguration of medicare, and the strike in health care service that lasted three weeks, a time during the summer of 1962 not to be critically ill.

This experiences are a reminder of the need to preserve personal memories of these events, especially as those who can remember through these times are now are at least in their sixties.

Please take the time to fill out our online survey; Saskatchewan MediCare & Doctor's Strike - 1962 Survey asking these questions:

What are your memories of the doctor's strike in 1962? Were you working in the medical field at the time?

What are your memories of life before medicare?

Where did you live?

How old were you (teens, twenties, etc.)?

How did you get information (newspapers, radio, TV)?

Was medicare or the strike a topic of conversation at home or work?

Were you or family members concerned about your health during the strike?

Were you covered by a municipal plan, MSI or other insurance?

If you worked in the medical field, what was the attitude of co-workers?

Please Phone or email Marilyn Decker, - - granddaughter of Matthew (Matthias) Anderson if you have any memories or reminiscences you could share.
Saskatchewan MediCare & Doctor's Strike - 1962 Survey




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