Pioneering Prepaid Care: The Hospitals Respond

The doctors were not the only health care providers who failed to get paid during the 1930s. Canadian hospitals found that, as the number of paying patients declined, their revenues fell, but their costs increased as they continued to serve the indigent. In 1934, the Hotel Dieu and Kingston General hospitals in Ontario and the four Edmonton hospitals led by the Royal Alexandra and University of Alberta hospitals pioneered prepaid hospital insurance plans similar to the Blue Cross programs that had originated in the United States. These plans provided a 15-day credit in private or semi-private rooms at $2.50 per day, or 20 days in the public ward at $1.75 per day. Male heads of households were charged $5 a year, $2 for their wives and $1 for each dependant.

This membership certificate lists the conditions of the insurance plan for the Kingston General Hospital and the Hotel Dieu Hospital. Notice that maternity cases were not covered and that people had to prove that they were poor enough to qualify for Public Ward Service.
Courtesy of the Kingston General Hospital Archive, Kingston, Ontario, Series 11, Kingston Hospitalization Group 500 B505. Used with permission.

Although this was an investment that middle- and upper-class professionals could make, it was usually beyond the reach of most working-class citizens unless their unions acquired it as part of a benefits package. For employed professionals, Dr. Jason Hannah, an Ontario government pathologist, created Associated Medical Services Inc. in 1937. Using start-up funding from the OMA, Hannah created a prepaid medical services insurance plan that quickly attracted civil servants and other professionals, as well as the self-employed. Associated Medical Services continued to provide this service until 1972.

A room at St. Michael’s Hospital, Toronto, circa 1930. During the Depression, hospital incomes declined because fewer patients could afford private care in a comfortable room like this one.
St. Michael’s Hospital Archives, AA-9. From Irene McDonald, C.S.J., For the Least of My Brethren: A Centenary History of St. Michael’s Hospital (Toronto: Dundurn Press, 1992), p. 105.

Public wards looked like this: rows of beds with no privacy for the patients. Shown here is the obstetrical ward at St. Michael’s Hospital, Toronto, circa 1939. It was not updated until 1964.
St. Michael’s Hospital Archives, G-1. From Irene McDonald, C.S.J., For the Least of My Brethren: A Centenary History of St. Michael’s Hospital (Toronto: Dundurn Press, 1992), p. 105.