But how were these to be financed? Traditionally, medical care had been a commodity that required payment from the patient to the practitioner at the time the service was provided. But, in recognition of the poverty of many working people, municipalities had undertaken to provide subsidies to local hospitals for institutional care, and churches and charitable organizations had encouraged doctors to provide their services free to the poor. To compensate for the loss of these fees, most doctors charged different rates depending on their assessment of a patient's ability to pay. Thus, the middle class and the wealthy were supporting care for the less affluent. As the population grew, however, many people did not make use of medical services because they feared the burden of debt charges, particularly once diagnostic tools such as X-rays and additional hospital accommodation became more readily available in the 1920s. As Dr. Kenneth MacKenzie of Halifax informed delegates at the 1929 Medical Services Conference:
Now, the poor man gets this service [diagnostic tests] in the public hospital
for nothing. On the other hand, the rich man is well able to pay for it at the
market price. But about sixty per cent of our population, I should say, belong
to a class whose earning powers are small and in order to balance their budget
they cannot afford these expensive forms of diagnosis and treatment. They are
too proud to accept them for nothing, and they are intelligent enough to want
to get the best that medical science can offer.
Now, if there is an evil there must be a remedy, and that remedy, as I see it, must
be some form of distribution of cost among the people at large. (Third Conference on Medical Services in Canada, House of Commons, November 20–21, 1929 [Ottawa: F. A. Acland, King's Printer, 1930], p. 37)
This 1924 schedule for Calgary hospitals shows that rates varied according to patient category. Patients who lived in the country and did not pay city taxes were charged higher rates. Courtesy of the Canadian Healthcare Association. From Hospital Buying, Vol. 1, No. 2 (March 1924), p. 15.
Transcription: Higher Rates at Calgary Hospitals
By a vote of six to five, the City Council of Calgary adopted the recommendation of the Commissioners, and the rates at the General and Isolation Hospitals have been advanced as shown in the following schedule:
All city patients $2 per day, present rate $1; maternity free; country patients $3, present rate $4.
City patients $3 per day, present rate $3.25 to $3.75; country patients $4 per day, present rate $4.25 to $4.75.
City patients $5.50 and $6; country patients the same