Abstract

This dissertation examines the development of hospitalization insurance in Canada and Quebec in the period from 1940 to 1960, focusing on the debate over health policy that began during the Second World War--when broad government-funded social programmes were being proposed--to 1960, when Quebec became the last province to join the national hospitalization insurance programme. It considers policy development on both the federal and provincial levels, as well as the response of two Montreal-area hospitals and their professional organizations to the perennial budget deficits and to the solutions proposed by government. It also examines the ideologies behind the choices that were made, both on the political level and in the hospital sector. Of particular interest is ongoing debate between two forms of liberalism: laissez-faire and state-interventionist. The dominant tendency for much of this period was the laissez-faire approach, that is, the belief that, overall, the market could proffer the best solutions to the problems of access to and financing of hospitals. This approach dominated both levels of government and, in the form of the liberal voluntary ethic, the hospitals as well. The other approach, which believed the state had a significant role to play in social welfare, was subordinate through much of the period, but eventually came to dominate. The hospitals themselves are an important focus of this study, particularly the contradiction between the desire of the voluntary hospital boards to keep their institutions autonomous from the state, and their incapacity to find adequate and durable solutions in the marketplace