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This article examines the origins, development, and evolution of the Newfoundland Cottage Hospital System (NCHS)—one of North America’s earliest efforts at publicly funded health care that involved the establishment of small “cottage” hospitals staffed by salaried medical personnel. The NCHS is compared with the Highlands and Islands Medical Service and cottage hospitals of Scotland which the established historical accounts suggest were the principal models for the Newfoundland system. The importance of the Newfoundland experience for the development of Canada’s national hospital insurance program is explained. The article concludes with an examination of the issue of salary remuneration within the NCHS.

Newfoundland’s Cottage Hospital System: 1920–1970