Consumer and Doctor-sponsored Medical Care Associations

Consumer and doctor-sponsored medical services associations offered pre-paid medical care to Saskatchewan residents prior to the establishment of medicare in 1962. In order for Saskatchewan’s urban residents to obtain pre-paid health services, the Mutual Medical and Hospital Benefit Association Act was passed in 1938, enabling any ten or more persons to incorporate a health insurance plan. The first association to organize under the Act was a co-operative headed by H.L. Fowler, manager of Consumer’s Co-operative Refineries, which in 1939 began collecting 80 cents a month from its members for the provision of medical care. The association attempted to hire doctors to work on salary, but switched to a fee-for-service basis to accommodate local doctors. Similar associations were established in Saskatoon, Prince Albert and Melfort. They were important participants in the debate on the form that a provincial medical services plan should take in the 1940s. In their submissions to the 1944 Sigerist Commission they opposed fee-for-service remuneration and insisted on a substantive role for ordinary citizens in the administration of health services, arguing that a provincial scheme should be financed predominantly from personal contributions rather than from general revenues. With the exception of the Saskatoon association, which rendered medical services up until 1962, the consumer plans either died or merged with the more successful doctor-sponsored plans.

The consumer-sponsored medical services associations were both the forerunners of Saskatchewan’s community clinics and also an important impetus to the establishment of the doctor-sponsored insurance schemes. The Regina District Medical Society organised Medical Services Incorporated (MSI) under the Companies Act in 1939 to compete with the Regina medical co-operative. MSI offered patients free choice of physician and remunerated doctors on a fee-for-service basis. It was the first doctor-sponsored insurance scheme established outside of Ontario, and was modeled on Dr. J.A. Hannah’s Toronto-based Associated Medical Services Incorporated. In 1949 MSI and the Regina Mutual Medical Benefit Association merged to form Group Medical Services (GMS).

The Saskatoon District Medical Society established Medical Services Incorporated (Saskatoon) in 1946, to deter the plans of the thriving Saskatoon Medical and Hospital Benefit Association to expand to larger rural centres, and to establish a group practice clinic in Saskatoon with 40 salaried physicians. When in 1959 the Douglas government announced its plans to implement medicare, MSI provided medical services to 217, 000 persons in both urban and rural Saskatchewan, and GMS had an enrollment of 91,000 persons. Of the consumer-sponsored plans, only the Saskatoon mutual remained, but its enrollment had declined to less than 5,000 persons.

The success of the doctor-sponsored plans, which they viewed as a viable and preferred alternative to a government-controlled medical care scheme, emboldened organized medicine to withdraw its support for a state-financed medical services plan in 1950. Although the last of the consumer-sponsored medical care plans were superseded by the implementation of Medicare, their enabling legislation—the Mutual Medical and Hospital Benefit Association Act—permitted the organization of community clinics during the 1962 doctors’ strike.

Gordon S. Lawson