Canada's Publicly Financed
Health Care System
Canada's health care system is a matter of pride for the majority of Canadians, for while it is not at the very top of the national morbidity and mortality indicators, it is not far off and it provides satisfying care for most citizens (Blendon et al. 1990). In the last ten years, however, the system has come under scrutiny in almost all provinces (Angus 1991; British Columbia 1991) and all governments have been concerned with the need for reform and restructuring.
In the first half of the twentieth century the growth of scientific medicine changed perceptions about the new importance of doctors' expertise in providing diagnosis and treatment for illness and this resulted in major changes in the organization of doctors' offices and hospital practice. Small communities in rural areas struggled to attract doctors to provide care and many worked out ingenious solutions (such as the Municipal Doctor Schemes on the prairies). Charity hospitals, which had often been a refuge for indigents in the nineteenth century, gradually separated out fee-paying patients from those who sought free care and became important treatment centres after they had managed to cope with infection control (Andrews 1979).
Most hospitals were in the cities, where they had often been set up as charitable foundations, though there were municipal hospitals in some rural areas and mission stations, usually on Indian reserves. By 1933 there were 589 public hospitals with 45,000 beds and approximately 300 private proprietary hospitals. 1____________________