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“In the 1940s, key provinces opposed the federal government proposals on health and fiscal changes were rejected, which forced a more piecemeal approach to the introduction of UHC [Universal Health Coverage] in the postwar years. In 1947, the Saskatchewan government implemented a universal hospital services plan. British Columbia (1948) and Alberta (1950) followed with their own “hospitalization” schemes. In 1957, the Government of Canada passed the Hospital Insurance and Diagnostic Services Act: this law set out the common conditions that provincial governments would have to satisfy in order to receive shared-cost financing through federal transfers. One year later in 1958, the provinces of Saskatchewan, BC, Alberta, Manitoba and Newfoundland agreed to work within the federal framework. By 1959, Ontario, Nova Scotia, New Brunswick and Prince Edward Island had also joined. Quebec did not agree until 1961, shortly after the election of a government dedicated to modernizing the provincial welfare state.”

Source: Marchildon G.P., Allin S., Merkur S. Canada: Health system review. Health Systems in Transition, 2020; 22(3): i–194.

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“With the introduction of federal cost-sharing for universal hospitalization, the Saskatchewan government was financially able to proceed with universal coverage for physician services. However, the introduction of the prepaid, publicly administered medical care insurance plan triggered a bitter, province-wide, doctors’ strike in 1962 that lasted for 23 days. The strike officially ended with a compromise known as the Saskatoon Agreement in which the nature and mechanism of payment emphasized the contractual autonomy of physicians from the provincial government, and fee-for-service as the dominant method of payment (Badgley & Wolfe, 1967; Marchildon & Schrijvers, 2011).

“In 1964, the Royal Commission on Health Services, commonly known as the Hall Commission, delivered its report to the Prime Minister. This federal commission had been established in the wake of the polarized debate in Saskatchewan about the merits of single-payer, universal medical care insurance as compared with the alternative of the state providing targeted subsidies for the purchase of private insurance as championed by provincial governments in Alberta, Manitoba and Ontario as well as organized medicine (Marchildon, 2016a). Ultimately, the Hall Commission leaned in favour of the Saskatchewan model, and recommended the federal government to encourage other provinces to implement universal medical care insurance through conditional grants (Canada, 1964). In 1966, the federal government passed the Medical Care Act with federal cost-sharing transfers to begin flowing in 1968 to those provinces that conformed to the four conditions of universality, public administration, comprehensiveness and portability. By 1971, all the provinces had implemented universal coverage for medical care to complement their existing universal coverage for hospital care. This FPT [Federal, Provincial, and Territorial] system of narrow but deep UHC [Universal Health Coverage] would become known as medicare (Marchildon, 2009).”

Source: Marchildon G.P., Allin S., Merkur S. Canada: Health system review. Health Systems in Transition, 2020; 22(3): i–194.

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.

Page last updated August 5, 2025 by Doug McVay, Editor.