Between 1929 and 1932, as the national and international economies collapsed, Canadians of all social classes were experiencing the most calamitous decline in their incomes ever. The average per capita income fell 48 per cent during the worst years of the Great Depression, with professional incomes declining by 36 per cent between 1928 and 1933. The cost of living fell by 25 per cent. In rural Ontario, one doctor received “twenty chickens, several ducks, geese, a turkey, potatoes and wood” as payment in 1933.
In Saskatchewan the situation was even worse. The sustained failure of the wheat crop meant that many communities could not afford to pay the salaries of their municipal doctors, who were then on relief like the majority of their patients. As well, 130 other practitioners in hard-hit areas were trying to subsist on an average of $27 per month. To keep them in the province, the provincial government paid them $75 per month for the next five years. By 1937, two-thirds of the province’s population was trying to survive on monthly relief payments of $20.20 for a family of five. Not surprisingly, many doctors left, and the doctor-to-patient ratio decreased from 1:1,579 in 1931 to 1:1,700 in 1941.
But concerned local politicians like Matt Anderson, a Norwegian immigrant, argued in favour of a municipal health insurance plan funded through annual individual or family premiums. In 1938, having gained the support of doctors in Regina, Anderson presented the measure to his colleagues on various regional councils, where straw votes found 80 per cent of the residents in favour of the project. By 1939, Anderson had persuaded the provincial government to introduce the Municipal Medical and Hospital Services Act, which was passed unanimously. Such local initiatives indicated the extent to which rural Canadians were seeking to control the costs of hospital and medical care.