Union hospitals, created to serve a particular geographical area through provincial legislation passed in both Saskatchewan and Alberta, represented a Western response to building and maintaining hospitals. Smaller communities in these provinces lacked the size to attract and maintain either charitable or private hospitals, whereas many urban hospitals in Eastern Canada either were charitable institutions or were run for profit by groups or individuals who relied on donations and municipal/provincial funding or patient fees. Saskatchewan’s union hospital districts grew from 10 in 1920 to 78 by early 1947. Alberta’s union hospital districts began with one in 1919 and grew to 11. The successful experiment with union hospitals in Saskatchewan and Alberta showed how municipal governments could effectively organize their rural voters to demand and obtain access to modern health services.