The Check-Off: A precursor of medicare in Canada?

Chryssa McAlister
Dalhousie University
Peter Twohig
Saint Mary’s University
CMAJ • December 6, 2005

The public system of health care insurance that exists in Canada today was implemented nationally in 1968
and was greatly influenced by the 1964 Royal Commission on Health Services, headed by Justice Emmett Hall.

When, in his final report, Justice Hall described the evolution of health care in Canada, he made brief reference to a health insurance system that existed in the Glace Bay colliery district of Cape Breton. Known as the “Check-Off,”this was a mandatory system whereby deductions were made from miners’ wages for a subscription to physician services, medications and hospital care. A reference to the Check-Off in minutes of the Nova Scotia Provincial Workmen’s Association suggests that it dates from about 1883, although at least one other historical reference places its origin even earlier, in the mid-19th century. It proved to be a durable system, surviving in Cape Breton mining towns until 1969, when it was replaced by provincial medical insurance administered by Maritime Medical Care.

One of us (C.M.) was first introduced to the Check-Off system by a Halifax-based surgeon, Dr. Allan MacDonald,who had done some general practice locums in Glace Bay in the 1960s. He suggested an interview with Dr. Joe Roach, a veteran of the system, who at 83 was still seeing 11 000 to12 000 patients a year and doing regular house calls. In researching the Check-Off system and preparing a CBC Radio
documentary, C.M. gained information through recorded personal interviews with participants in the system, including patients, physicians, hospital administrators, politicians and union organizers. In this article, we convey the essence of the interviews; the unedited conversations can be accessed through the Dalhousie University Medical Humanities Webpage (www.library.dal.ca/kellogg/subjects/medhumanities/cbcheckoff/intro_cbcheckoff.htm).

The Check-Off system reflected the paternalistic philosophy of the times.The coal company built and owned the houses in the town, the power plant, the water facility and the grocery stores. The employer deducted from each miner’s weekly pay the costs associated with daily life, including rent, water, sanitation, supplies, coal, company store bills and check-weighman  (The check-weighman would verify the weight of each miner’s load of coal to determine how much money he would make. Miners were paid according to the amount of coal they extracted each day.) The Check-Off evolved to include union dues, relief associations, and physician and hospital services.

Read more HERE. (pdf)