In Newfoundland and Labrador, the cottage hospital system that had been introduced in 1934 provided citizens in the outports with access to hospital and medical services. As Margaret MacDonald of Kilbride recalls: “This was the first instance in North America of a government-established, and subsidized, hospital and medical care plan set up on a prepayment basis. Costs to individuals were $5 to $7 per year or $15 per family” (Helen Heeney, comp., Life Before Medicare: Canadian Experiences [Toronto: Ontario Coalition of Senior Citizens’ Organizations, 1995], p. 32).
By 1954, 120,000 inhabitants were paying annual premiums for doctors, nurses and hospitals along the province’s coasts. Like the Alberta, British Columbia and Saskatchewan plans, the province’s general revenues were used to subsidize the costs. But in contrast to the other provinces, doctors working in the cottage hospitals were paid a salary. To some, this was the clearest example of state medicine in the Canadian context. But, given the isolation and relatively small population in most outports, few health professionals in this province would have voluntarily agreed to attempt to practise fee-for-service medicine. So the Newfoundland model demonstrated a local adaptation intended to bring the benefits of modern medical care to remote areas.