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 PROVINCE OF BRITISH COLUMBIA
"HOSPITAL INSURANCE ACT"
Fifth Annual Report
B.C. Hospital Insurance
Service
JANUARY 1st TO DECEMBER 31st
1953
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1954  Victoria, B.C., February 16th, 1954.
To His Honour Clarence Wallace, C.B.E.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
The undersigned has the honour to present the Fifth Annual Report of the B.C.
Hospital Insurance Service covering the calendar year 1953.
E. C. MARTIN,
Minister of Health and Welfare. B.C. Hospital Insurance Service,
Victoria, B.C., February 16th, 1954.
The Honourable E. C. Martin,
Minister of Health and Welfare,
Parliament Buildings, Victoria, B.C.
Sir,—I have the honour to present herewith the Report of the B.C. Hospital
Insurance Service covering the calendar year 1953.
L. F. DETWILLER,
Commissioner, B.C. Hospital Insurance Service. CONTENTS
Page
General Introduction   7
Insurance (a)—■
The Collection of Revenue  7
Insurance (b)—
Claims and Accounting  8
Method of Payment to Hospitals  8
Hospital Services  9
Summary  9
Organization and Administration—
Registration and Collection—
Payroll Division   10
Field Division :  10
Tabulating Division  10
Central Accounts Division  11
Departmental Comptroller  11
Public Relations  11
Liability and Adjustment Division  12
Research Division  12
Hospital Services Group  12
Hospital Finance Division—
Hospital Claims Section  13
Hospital Accounting Section  13
Hopsital Consultation and Inspection Division, Victoria  13
Hospital Consultation and Inspection Division, Vancouver  14
Medical Consultation Division  15
Hospital Construction Division  15
General Hospital Care  16
Table Ia.—Patients Discharged and Days of Care in B.C. Public Hospitals,
1949-53, and Proportion Covered by B.C. Hospital Insurance Service  16
Table Ib.—Percentage of Patients Covered by B.C. Hospital Insurance Service
during 1953  17
Table IIa.—Patients Discharged, Total Days' Stay, and Average Length of Stay
According to Type and Location of Hospital, and Days of Care per Thousand of Covered Population for B.C.H.I.S. Patients Only, 1949-53  17
Table IIb.—Summary of the Number of B.C.H.I.S. In-patients and Short-stay
Patients, 1949-53  17
Table III.—Patients Discharged, Total Days' Stay, and Average Length of Stay
in B.C. Public Hospitals for B.C.H.I.S. Patients Only, Grouped According
to Bed Capacity, Year 1953  18
Table IV.—Percentage Distribution of Patients Discharged and Patient-days for
B.C.H.I.S. Patients Only, in B.C. Public Hospitals, Grouped According to
Bed Capacity, Year 1953  18
5 NN 6 BRITISH COLUMBIA
Graphs  Page
Principal Causes of Hospitalization, July 1st to December 31st, 1952  19
Average Lengths of Stay for Nineteen Major Diagnostic Categories of Illness,
July 1st to December 31st, 1952  20
Case Fatality Rates for Nineteen Major Diagnostic Categories of Illness, July 1st
to December 31st, 1952  21
Statements—
Statement of Receipts and Disbursements for the Fiscal Year 1952-53, Ended
March 31 st, 1953  22
Statement Showing Cash Reconciliation with the Public Accounts of the Province
of British Columbia as at March 31st, 1953  23
Benefits in B.C. Hospitals, 1953  24
Benefits in Hospitals outside British Columbia  24
Classes of Persons Covered by or Excluded from the Benefits of the Hospital Insurance Service  24 Fifth Annual Report of the B.C. Hospital
Insurance Service
GENERAL INTRODUCTION
The main purpose of the B.C. Hospital Insurance Service is to provide universal
and comprehensive coverage against the cost of acute in-patient hospital care to the
people of British Columbia. It exists to answer two definite needs: to protect the people
of British Columbia from crippling hospital bills, and to protect the hospitals of British
Columbia from a large proportion of non-collectable accounts. Sufficient proof of these
needs lies in the fact that before the inception of the B.C. Hospital Insurance Service as
many as 35 to 55 per cent of the patients of some hospitals could not afford to pay
their bills.
Universal coverage—coverage of all—is achieved in three principal ways:—
(1) The " Hospital Insurance Act" requires every citizen, with the exception
of certain small groups, to pay hospital insurance premiums or have them
paid on his or her behalf; thus all categories are included, regardless of
age or physical condition:
(2) The regulations to the "Hospital Insurance Act" allow the inclusion of
a wide range of family dependents:
(3) Groups receiving social-welfare assistance from the Provincial Government
receive hospital insurance coverage paid for by the Province.
Comprehensive coverage is achieved by making available to the insured patient
substantially all of the hospital's services in return for the premium paid (see Benefits,
page 24).    Benefits consist of:—
(1) Payments at the public-ward level for acute treatment that can be obtained
only in an acute general hospital:
(2) Payments for emergency treatment (short-stay benefits);  and
(3) Payments for treatment in hospitals outside British Columbia (out-of-
Province benefits).
The B.C. Hospital Insurance Service has two broad functions—insurance and
hospital services. The insurance side, in turn, is broken down into two main parts, which
are as follows:—
Insurance (a)
The Collection of Revenue
Premium Rates.—These are $27 a year for a single registrant and $39 a year for
the head of a family and his dependents, or approximately 8 cents a day and 11 cents
a day respectively.
Methods of Payment.—There are two methods of payment—payroll deduction and
direct payment.
Payroll Deduction.—This has been recognized as the most practical method of
collection. Over one-half of the people in British Columbia pay their premiums in this
way, and expansion of the system to include as many employed persons as possible was
begun in the latter half of 1953. Standard monthly deductions of $2.25 and $3.25
a month are made in advance through employers, and, as a result of the new payment
plan introduced on July 1st, 1953 (see New Payment Plan, page 10), registrants are
eligible for benefits during the month for which a deduction has been made;   those NN 8 BRITISH COLUMBIA
registrants whose premiums were paid six months in advance under the old payroll system
maintain their payments and the advance protection.
Direct Payment.—Those persons not participating in the payroll deduction plan are
billed direct from Victoria every six months for the following six-month insurance period,
from January to June or from July to December. Registrants who have paid the premium
for the current six-month insurance period by due date are eligible for benefits during
that period.
The improved collection procedure, implemented in 1953, was responsible for
several changes in collection policy. Effective July 1st, all arrears were suspended to
enable registrants who had fallen behind with premium payments to reinstate their
coverage, subject to the following waiting periods:—
(1) Persons who have paid regularly but who miss paying their current
premium by the due date are subject, upon payment of premium, to
a fourteen-day waiting period before being eligible for benefits:
(2) Persons who have not paid their premium for the previous insurance
period can reinstate themselves by paying the full premium for the current
insurance period. To prevent abuse of the new plan, such persons are
subject to a one-month waiting period before becoming eligible for benefits.
On the same date, a new feature, "insured benefits," was introduced, to begin to
take effect from January 1st, 1954. All persons who regularly pay their hospital insurance
premiums build up an " insured benefits " period. One month's " insured benefits " are
acquired at the end of each full-paid six-month insurance period. This will continue to
build up, provided all premiums are regularly paid until a maximum " insured benefits "
period of three months is attained at the end of eighteen months of premium payment.
This " insured benefits " period will be available during unemployment or when direct
payment of premium by the due date is not possible owing to temporary financial
difficulties.    AH B.C.H.I.S. benefits will be available during this period.
Insurance (b)
Claims and Accounting
The second part of the insurance side of the Hospital Insurance Service, which is
organized under the Hospital Services Group (see page 12), is concerned with the
redistribution to the hospitals of the money collected in premiums. This is accomplished
through the meeting of claims—the payment of the insured patients' hospital bills—at
daily rates established under the budget system after review of hospital accounting records.
Method of Payment to Hospitals
Effective January 1st, 1951, a system of firm budgets was instituted for hospitals.
Under this system, hospital estimates submitted were reviewed by the Rate Board of the
Hospital Insurance Service, and, after such adjustments as were found necessary, the
resulting budgets were established. Hospitals were advised that, with the exception of
certain items (particularly fluctuation in days' treatment), they would be required to live
within their approved budgets, and that deficits incurred through expenditures in excess
of the approved budget would not be met. Calculations were made to determine the value
of variable supplies used in the care of patients. The budgets were subject to adjustment
upward or downward by the number of days by which the actual experience differed from
the estimate, multiplied by the patient-day value of the variable supplies. In those
instances where the fluctuations in occupancy were sufficiently great to entail additions
to or reductions in stand-by costs, individual studies were made and budget adjustments
established.
During 1953 this procedure was modified somewhat, and hospitals were required to
operate on their budgets as approved for 1952 and per diem rates were not increased. HOSPITAL INSURANCE SERVICE REPORT,  1953
NN 9
However, authority was given the Service to adjust a hospital's budget, up to the amount
of 1953 salary increases paid to employees included in the 1952 approved budget, where
such increased wage rates caused the hospital to incur an operating deficit.
Owing to the fact that all hospitals treat a certain number of non-B.C.H.I.S. patients
(Workmen's Compensation Board, transients, non-insured individuals, and persons
exempt from hospital insurance coverage by reason of membership in the Canadian
Pacific Railway and B.C. Telephone medical plans), the Service is not responsible for the
entire patient-load. The Service, therefore, pays to each hospital each month the portion
of one-twelfth of the yearly budget that is represented by the B.C.H.I.S. insured days as
compared to the total days' treatment. Remittances to hospitals are made twice monthly.
At the end of any month each hospital is paid the approximate amount of its earnings
to date for B.C.H.I.S. patients, including those remaining in hospital at the end of the
month. All insured patients are required to pay $1 for each day's hospitalization. The
$1 a day collectable from insured persons is deducted in calculating payments due to
hospitals from the Service.
Hospitals collect from non-insured persons at established per diem rates.
Hospital Services
The other main function of the B.C. Hospital Insurance Service is that concerned
with what the patient receives from the hospital in return for the money paid on his
behalf, the standards of patient care (see Hospital Services Group, page 12).
The group of staff consultants who share this responsibility are organized into the
following divisions:—
Hospital Finance (in addition to its activities in the insurance side of the Service):
To give advice to hospitals on problems of accounting and finance.
Consultation and Inspection:    To assist hospitals with administrative  and
operational problems and ensure that proper standards of patient care are
maintained at all times.
Medical Consultation:   To review all medical matters affecting the Service
under the advice and guidance of a Medical Review Board.
Hospital Construction:   To give advice to hospitals in the preparation of plans
for new buildings and renovations and to process applications for grants
for construction and purchase of equipment.
Research:*   To conduct studies of hospital occupancy and develop medical
and financial information required to guide the Service regarding the
hospital requirements of the people of the Province.
Liability and Adjustment: *   To assist in the formation of hospital districts in
areas where no municipal organizations exist and to give guidance in the
review of hospital by-laws and the many related problems.
These expert advisory services are available at every stage of the construction of
a hospital and in every phase of its operation.
Summary
In summary, the B.C. Hospital Insurance Service protects the patient from hospital
bills, both large and small, and the hospitals from a large proportion of uncollectable
accounts. From the point of view of the insured citizen, maintenance of the standards
of care is assured. From the point of view of the hospitals, although the Hospital
Insurance Service inevitably exercises a broad over-all financial control in handling their
revenue, autonomy as community hospitals is retained.
* Not organized specifically under Hospital Services Group as the work ot these divisions is utilized by the whole
Service. NN 10 BRITISH COLUMBIA
ORGANIZATION AND ADMINISTRATION
Registration and Collection
Payroll Division
On December 31st, 1953, 5,100 firms were registered for payroll deductions and
making monthly deductions of British Columbia hospital insurance premiums from their
employees. Two hundred and twenty-eight thousand registrants were paying their
premiums through the payroll deduction plan. This number represents protection against
hospital bills for more than 500,000 persons in British Columbia.
New Payment Plan.—On July 1st, 1953, the Government eliminated the six months'
prepayment of premium and the collection of premium arrears by payroll deductions.
After this date, employers were billed for standard monthly premiums on a month-for-
month basis in accordance with the new payment plan. Prepayments resulting from the
former plan were credited to the accounts concerned. As a result of the change in procedure, there was a marked reduction in the amount of work required by employers and
the Service in the administration of the payroll plan.
During the months of August and September a simplified accounting procedure was
developed for payroll accounts. This new procedure involved the extensive use of
punched-card methods and of tabulating equipment.
The simplified payment plan and the improved accounting and record system commenced on October 1st, 1953, permitting expansion of the payroll deduction plan in the
last half of the year.
Registration of New Employees.—The intensive programme for the registration
of new employers and the enrolment of their employees in the payroll plan resulted in
the commencement of deductions in December, 1953, by 1,500 new employers from
35,000 employees.
Field Division
The Hospital Insurance Service was represented by the Field Division throughout
the Province as follows:—
(1) Four Hospital Insurance Service district offices, located in Chilliwack,
New Westminster, Vancouver, and Victoria:
(2) Seven collection offices, operating on a commission basis—six located in
Fraser Valley communities and one at Trail:
(3) Thirty-nine Government Agencies, where premium payments were
accepted and general information was provided.
Payroll Expansion.—A programme to expand the payroll deduction plan was undertaken in September and October by the Field Division in conjunction with Payroll Division.   No difficulty was experienced in enlisting the co-operation of employers.
Throughout the year this Division provided service to the general public and to all
firms enrolled under the payroll deduction plan.
Tabulating Division
Major projects completed during the year were as follows:—
A wide variety of statistical reports were prepared for the Research Division. All
statistical cards accumulated from the 1952 hospital discharge forms were included in
these reports. Four new accounting-machines were installed, replacing older-style
machines and enabling the Division to accomplish the additional punched-card accounting work necessitated by the major changes to the accounting system that were adopted
in 1953. Preparation of billing files for new companies registered as a result of the
payroll expansion programme was completed. HOSPITAL INSURANCE SERVICE REPORT,  1953
NN 11
Routine work included the preparation of monthly group billings for all registrants
on payroll deduction, of two semi-annual billings for all direct-paying registrants and
two arrears billings for delinquents, the weekly preparation of hospital remittance lists,
billings to municipalities for the per diem grant, and statements to patients for income-tax
purposes for all hospital accounts submitted during the year, and the daily processing of
cash and adjustments to provide a daily entry journal covering all accounts held by the
Hospital Insurance Service.
Central Accounts Division
The past year was marked by two important administrative and organizational
changes:—
(1) The use of punched cards was extended in premium accounting in conjunction with the simplification and expansion of the payroll deduction
method of collecting premiums.
(2) A central registry was established, containing approximately 700,000 files,
one for every person registered under the " Hospital Insurance Act."
The Division records all premium payments, both direct and through payroll deduction, and all exemptions (see Table V, Claims for Exemption, page 25), as well as
maintaining an index of all persons registered under the " Hospital Insurance Act."
Departmental Comptroller
All disbursements relative to premium refunds, payments to hospitals, advance
warrants, travelling expenses, and trade accounts incurred by the Hospital Insurance
Service were checked, approved, and passed for payment.
The accounting operation for the three Provincial Infirmaries was supervised, and
all financial transactions relative to the construction, renovation, and equipping of hospitals were checked and recorded.
An internal audit of the Hospital Insurance Service and its collection agencies was
completed. Statements relating to revenue and expenditure were prepared and issued
monthly.
The premium revenue of the entire Hospital Insurance Service was checked and
cashiered.
An inquiry office was operated at head office to receive premium payments and
transact other hospital insurance business with the public.
The number of receipts for Payroll Division payments cashiered at head office from
January 1st, 1953, to December 31st, 1953, was over 43,000. Central Accounts receipts
during the same period exceeded 350,000.
Office supplies were requisitioned, furniture and equipment were maintained, and
stationery inventories kept.
Public Relations
The organization and execution of localized publicity campaigns, designed to " sell "
the B.C. Hospital Insurance Service, was the major project of the year's activities. Radio
and newspaper campaigns were conducted by staff members in Prince Rupert, Prince
George, Quesnel, and Kamloops at different times during the last five months of the year.
From January to August the Service's News Letter (35,000 circulation) received
priority and necessitated repeated trips into the field for the purpose of obtaining specialized material. On these occasions every effort was made to improve the Service's public
relations through the media of the press, radio, and public speaking. At the request of
many hospitals, detailed information was made available on such matters as opening-
days, community relations, and public relations.
The bulletin was expanded in March to include hospital news in addition to the
Service's administration features, and space was made available to the hospitals to NN 12 BRITISH COLUMBIA
publicize their needs for, or surplus of, equipment, thereby making possible exchanges
and purchases with economy and to the common advantage.
Two pamphlets were prepared for public consumption, along with advertising
material for semi-annual premium-payment campaigns. Articles written and submitted,
together with photographs, were from time to time published in British Columbia newspapers and the " Canadian Hospital " magazine.
An internal public-relations programme was continued.
Liability and Adjustment Division
This Division prepared legislation, regulations, and Orders in Council, and was
responsible for liaison between the B.C. Hospital Insurance Service and the Attorney-
General's Department.
It provided a consulting service to the other divisions of B.C. Hospital Insurance
Service, to ensure that a uniform interpretation of the various Acts and regulations was
maintained throughout the Service.
The Division also assisted communities in unorganized territory to establish hospital
improvement districts for the purpose of raising funds for hospital construction, and
assisted hospitals in the review and revision of by-laws in collaboration with the Hospital
Consultation and Inspection Division.
In addition, this Division collected reports on all persons involved in accidents who
received hospital treatment and secured reimbursement of hospital bills paid by the
Service from public-liability insurance companies and self-insured corporations under
an agreement which has been in effect for some years.
Research Division
During 1953 numerous studies dealing with Provincial hospital experience and
requirements, sickness incidence, population trends, and income statistics were completed.
Hospital Bed Facilities.—Detailed reports were prepared on the hospital bed facilities of ten districts in order to determine the additional number which would be required
to serve adequately the needs of these areas. The assessment of the hospital bed needs
was based on incidence of sickness, utilization of hospital facilities within the Province
by the residents, population trends, geographic location, climatic conditions, transportation facilities and costs, type of economy which supports the area, and the financial
structures of the municipalities involved. Where it was felt that a particular area needed
special attention, staff members visited the district concerned to gather additional information. A study to estimate the hospital bed requirements of the Lower Fraser Valley
was commenced at the end of the year.
Causes of Hospitalization.—In April a statistical analysis of the causes of hospitalization among British Columbia residents was completed. The report was based on the
medical data appearing on the admission-discharge forms submitted by the hospitals to
the Service and represented the first attempt made by this Division to summarize the
details of the individual admissions and to present them in a useful form.
Major Statistical Studies.—Other major statistical studies completed: Six population studies, twelve hospitalization experience reports, two studies on recipients of social
welfare, and a study on maternity cases and new-born babies.
In addition to supplying statistical information pertaining to hospitalization and
disease incidence to other branches of the Service and the Provincial Government, information was gathered and compiled for government services throughout Canada and the
United States.
Hospital Services Group
The Hospital Services Group comprises that part of the Hospital Insurance Service
which deals with hospitals and with hospital matters.    Its four divisions are Hospital HOSPITAL INSURANCE SERVICE REPORT, 1953
NN 13
Finance, Hospital Consultation and Inspection, Medical Consultation, and Hospital
Construction.
Hospital Finance Division
Hospital Claims Section
The main functions of this Section were to advise hospitals of patients' eligibility
status and to screen and process hospital accounts for payment. Approximately 900
admission notices and an equal number of hospital accounts were received each working-
day throughout the year. Admission notice forms were screened by the Medical Consultant's Division before the patient's eligibility status was determined. Hospitals were
notified with regard to B.C.H.I.S. responsibility on each admission notice received.
During 1953, 208,111 hospital accounts were processed and approved for payment,
an increase of 18,240 over 1952. This total included 3,131 out-of-Province accounts,
paid on behalf of beneficiaries who were admitted to hospitals in other Provinces of
Canada, United States, South America, and many European countries, and other areas
of the world.
During 1953 this Section paid hospital accounts for persons in receipt of welfare
funds, and then billed and recovered reimbursement from the Provincial Welfare Branch.
The previous year's records—over 610,000 documents—were microfilmed, effecting
a considerable saving in filing space and equipment.
Hospital Accounting Section
This Section was primarily concerned with hospital budgets, maintaining close
working relations with the hospitals, and the inspection of hospital accounting records.
Frequent inspections were made of hospital financial and statistical records. Where
smaller hospitals had changes in accounting staff, and local assistance was not available,
this Section, upon request, sent accountants to write up the hospital's books and to train
new staff.
Monthly statistical reports and statements of revenue and expenditure were received
from hospitals and compared with the approved budgets, and cash advances were calculated and made semi-monthly.
The Annual Hospital Report for 1952, required under the " Hospital Act," was
prepared; financial and statistical reports prepared by hospitals for the Dominion Bureau
of Statistics were checked and amended; requests for payment of grants in connection
with capital expenditures made by hospitals for equipment were studied and recommended for approval; audits of accounts relating to hospital-construction projects were
carried out in collaboration with Federal Treasury officials; and accounting studies were
carried out in nursing homes and chronic hospitals at the request of the Provincial Welfare Branch, to assist them in establishing rates to be paid for the care of welfare patients.
Hospital Consultation and Inspection Division, Victoria
During the year this Division continued its programme of hospital inspection and
its efforts to help hospitals with their administrative problems. It assisted other divisions
of the Service in their work relating to hospitals.
Members of the staff visited forty-eight hospitals. Duration of visits varied from
one or two days, in cases of regular inspection, to a week where hospitals had specifically
requested a longer visit.
Revision of By-laws.—Many hospitals reviewed and undertook revision of then-
by-laws. Revised by-laws of twenty-five hospitals were processed during the year in
co-operation with the Liability and Adjustment Division. Medical staffs of hospitals
were active in developing new medical-staff by-laws; the Division assisted by providing
reference material.    Several sets of newly developed by-laws were received for comment. NN 14 BRITISH COLUMBIA
Personnel Procedures Reviews.—Information on personnel matters was distributed,
and a sample set of personnel policies was developed to assist smaller hospitals. The
manual of medical-record procedures developed in 1952 was tested in several hospitals
during the year, and general distribution of the manual was started in December. The
manual is especially intended for use by hospitals which do not have a trained medical-
record librarian. The Division continued to assist in reviewing hospital estimates and
was represented on the Hospital Rate Board. The staff also helped with the review of
hospital plans, requests for equipment grants, and acted as official representatives of the
Service at three regional hospital meetings.
By request, nutrition consultants of the Provincial Health Branch visited a number
of hospitals. This continued the co-operative arrangement with this Service started in
1952. Information on the day-to-day utilization of beds in the Greater Vancouver
and New Westminster areas was assembled throughout the year.
Hospital Consultation and Inspection Division, Vancouver
A hospital consultation and inspection service, the licensing and inspection of private
hospitals, the hospital-clearance programme, and the screening of applications for admission to the Provincial Infirmary were carried on by the Vancouver office during 1953.
Close liaison was maintained with the Social Welfare Branch. Investigations were made
and service given in matters referred to by other divisions of the Hospital Insurance
Service.
There were fifty-four licensed private hospitals in the Province on December 31st,
1953.
Cases Referred.—Two hundred and ninety-three problem cases were referred by
general hospitals throughout the Province, for whom request for removal from hospital
was made and which involved referral to and investigation by the Social Welfare Branch.
There were thirty-one inquiry cases where interpretation was given to hospitals
regarding hospital-clearance cases, but where service was not given by the Social Welfare
Branch and where the cases did not constitute true hospital clearance. Eleven inquiries
were received concerning situations where hospitals or persons requested information
involving other departments of the Government, but which did not pertain to either
hospital clearance or private hospitals. While some of these inquiries were directed to
the Hospital Insurance Service, they were not, upon investigation, necessarily hospital
insurance problems and were therefore, in turn, referred to the agency or department
responsible for the case-handling. Fifty-six inquiries were made regarding the establishment of private hospitals. Seven new private-hospital licences were issued and three
private hospitals ceased operation during the year.
Inspectional Visits.—An annual inspectional visit was made to all licensed private
hospitals. Any complaints received with respect to the operation of any private hospital
were thoroughly investigated. Interpretation and guidance were given to private hospitals
upon request and, as a result, a large number of the private hospitals were visited several
times.
A number of private hospitals voluntarily made inquiries with respect to improving
conditions and service facilities within their private hospitals. A larger number of private
hospitals evidenced interest in, and have actually established, diversional and recreational
programmes for patients under care.
One hundred and two applications for admission to the Provincial Infirmary were
received and considered. Of these, ninety-eight were recommended for Infirmary
admission. This Division continued to administer the " Mental Hospitals Act," sections
6 and 7. There is one licensed private mental hospital in the Province, and two borderline homes under observation and supervision by the Inspector of Hospitals for the
Medical Superintendent of the Provincial Mental Hospital under section 6 of the " Mental
Hospitals Act." HOSPITAL INSURANCE SERVICE REPORT, 1953
Medical Consultation Division
NN 15
In essence, the function of this Division is to supply technical knowledge to all
branches of the Service requiring it. The Medical Consultant, along with the Assistant
Commissioner in charge of hospital services, represents the Service on the Medical Review
Board. The other three members of this Board are physicians designated by the College
of Physicians and Surgeons of British Columbia. The Board, by its advice and guidance,
does much to create and maintain good relations among the Service, the medical
profession, and the hospitals.
In accordance with the British Columbia " Hospital Insurance Act" and its regulations, the Medical Consultant and his staff review and approve all hospital accounts
from a medical point of view before payment to the hospitals, giving particular attention
to chronic and short-stay patients. Medical statistics are prepared under the guidance
of the Medical Consultant. In the majority of hospitals visited during 1953 by the
Medical Consultant, advice was given, in conjunction with other divisions, in connection
with drug usage and the purchase of hospital equipment. A new procedure for the
submission of medical-treatment forms by hospitals was introduced, to ensure that correct
diagnoses were provided, with the object of improving the accuracy of medical statistics.
Hospital Construction Division
The primary function of this Division was to render an advisory or consulting
service to hospitals or hospital groups contemplating building improvements, reconstruction, additions to existing structures, or the construction of a new hospital. Reference
material on the planning and construction of hospitals is available, and was loaned upon
request to interested groups.
During 1953, hospital projects were completed at Powell River (7 beds), Penticton
(121 beds), Creston (28 beds), Abbotsford (50 beds), North Vancouver (22 beds),
and the St. Vincent's Hospital addition at Vancouver was substantially completed, which
provided an increase of 141 beds. A new boiler plant was brought into operation at the
Providence Hospital, Fort St. John, and at Rossland a new kitchen and laundry were
finished.
During the year, hospital projects were under way at Pouce Coupe, St. Paul's in
Vancouver, Trail, White Rock, and Tofino. The Vancouver General Hospital continued
with its main-building alterations and heating- and power-plant projects. Two chronic-
and convalescent-hospital projects were started in Vancouver—the Holy Family Hospital
and the Western Society for Rehabilitation.
Provincial payments based upon progress certificates submitted by hospitals undertaking construction projects in 1953 amounted to $2,877,326, which would represent
a gross expenditure of $4,804,903.
On December 7th, 1953, the Government approved a revised financing formula for
hospital construction. The new formula eliminated the repayable loan previously
advanced by the Province and provided an outright grant of 50 per cent for approved
costs of new projects.
The Division also advised hospitals and hospital groups of the financing formulae
of the Federal and Provincial Governments and outlined in detail the conditions attached
to their financial assistance. Federal and Provincial grants became available to hospitals
only after the approval of the project in principle and a detailed review of the plans by
the Hospital Insurance Service. Particular attention was paid to the design, to make sure
it would permit quality of care, efficient and economical operation, and adequate provision
for expansion. Specifications and contract documents were also submitted to this Service
for review. Fourteen major reviews of hospital projects were completed during 1953,
and several site inspections were undertaken. NN 16
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BRITISH COLUMBIA
This Division acts on behalf of the Federal Government to ensure that its minimum
standards are met. This includes ensuring that the plans satisfy the Provincial Fire
Marshal, and that minimum floor areas, corridor-widths, and adequate services exist.
GENERAL HOSPITAL CARE
Statistical data compiled by the Hospital Finance Division and dealing with the
volume of hospital care provided to the population of British Columbia by the Service
are presented in the tables on the following pages. Seventy-eight public hospitals
were approved to accept B.C.H.I.S. patients. In addition, a proportion of care was
given in company-operated hospitals in remote areas and in Red Cross outpost units and
the veterans' hospitals at Vancouver and Victoria.
The 1953 data given have been prepared from preliminary unrevised reports
submitted by the hospitals of the Province and are subject to minor revision.
The average length of stay of B.C.H.I.S. adult and children patients in British
Columbia public hospitals decreased from 10.17 days in 1952 to 10.12 days in 1953.
The total adult and children days covered by B.C. Hospital Insurance Service in British
Columbia public hospitals were 1,712,494 during 1953, an increase of 142,520 or
9 per cent over 1952.
A total of 169,259 B.C.H.I.S. adult and children patients were discharged from
British Columbia public hospitals during 1953, an increase of 14,923 or 9.7 per cent
over 1952. This marked increase in the number of B.C.H.I.S. patients and patient-days
is equivalent to the total increase experienced during the preceding three years. It would
appear that additional hospital accommodation, made available through construction, is
an important factor in this situation.
Table Ia.—Patients Discharged and Days of Care in B.C. Public Hospitals,
1949-53, and Proportion Covered by B.C. Hospital Insurance Service
Total Hospitalized
Covered by B.C.H.I.S.1
Adults and
Children
New-born
Total
Adults and
Children
New-born
Total
Patients discharged—
1949	
1950. _ 	
1951	
19522	
1953	
Percentage of total, patients discharged-
1949 	
1950	
1951	
1952=....
1953......
Patient-days—
1949	
1950	
1951	
19522	
1953	
Percentage of total, patient-days—
1949   	
1950  	
1951  	
19522..
1953....
164,964
26,272
191,236
172,645
26,205
198,850
181,160
27,096
208,256
188,355
28,675
217,030
200,985
29,915
230,900
1,682,196
213,874
1,896,070
1,766,680
212,979
1,979,659
1,795,438
214,285
2,009,723
1,916,486
214,701
2,131,187
2,041,231
220,317
2,261,548
	
	
	
140,168
144,959
150,116
154,336
169,259
84.9
84.0
82.9
81.9
84.2
1,430,646
1,476,615
1,467,102
1,569,974
1,712,494
85.0
83.6
81.7
81.9
83.9
24,640
23,943
24,172
25,023
27,033
93.8
91.4
89.2
87.3
90.4
200,585
193,307
187,891
184,160
197,209
93.8
90.8
87.7
85.8
89.5
164,808
168,902
174,288
179,359
196,292s
86.2
84.9
83.7
82.6
85.0
1,631,231
1,669,922
1,654,993
1,754,134
1,909,703s
86.0
84.4
82.3
82.3
84.4
1 B.C.H.I.S. excludes Workmen's Compensation Board patients and days.
3 Amended as per final reports received from hospitals.
3 New-born total included. HOSPITAL INSURANCE SERVICE REPORT,  1953
NN 17
Table Ib.—Percentage of Patients Covered by B.C. Hospital
Insurance Service during 1953
Per Cent
Patients charged to agencies—Workmen's Compensation Board, approved insurance plans, and
Federal Government
Self-responsible—non-B.C.  residents
Subject to B.C.H.I.S. coverage 	
7.7
1.0
91.3
100.0
B.C.H.I.S. patients hospitalized (85.0 per cent of total, see Table Ia) in relation to proportion
of patients subject to insurance coverage (91.3 per cent, see Table Ib)    93.1
Table IIa.—Patients Discharged, Total Days' Stay, and Average Length of
Stay According to Type and Location of Hospital, and Days of Care per
Thousand of Covered Population for B.C.H.I.S. Patients Only, 1949-53.
Total
Adults and I    New-
Children  I    born
I
B.C. Public
Hospitals
Adults and I    New-
Children  I    born
B.C. Private
Hospitals
Adults and
Children
Newborn
Institutions
outside B.C.
Adults and
Children
Newborn
Patients discharged-
1949 	
1950	
1951  	
19521	
1953	
Patient-days—
1949	
1950	
1951	
19521 	
1953 	
Average days of stay-
1949 	
1950..... 	
1951	
19521	
1953	
149,280
154,643
159,739
164,379
180,543 s
1,498,121
1,564,222
1,551,954
1,663,149
1,814,1462
10.03
10.11
9.71
10.12
10.04
24,989
140,168
24,640
24,336
144,959
23,943
24,587
150,116
24,172
25,492
154,336
25,023
27,568
169,259
27,033
203,197
1,430,646
200,585
196,333
1,476,615
193,307
190,948
1,467,102
187,891
187,923
1,569,974
184,160
201,081
1,712,494
197,209
8.13
10.21
8.14
8.07
10.19
8.07
7.76
9.77
7.77
7.37
10.17
7.36
7.29
10.12
7.30
7,093
151
7,617
173
7,308
171
7,431
161
8,475
213
45,960
1,146
65,326
1,288
62,771
1,155
68,892
974
75,704
1,287
6.48
7.59
8.58
7.44
8.59
6.75
9.27
6.05
8.93
6.04
2,019
2,067
2,315
2,612
2,809
21,515
22,281
22,081
24,283
25,948
10.66
10.78
9.54
9.29
9.24
198
220
244
308
322
1,466
1,738
1,902
2,789
2,585
7.40
7.90
7.79
9.06
8.03
1 Amended as per final reports received from hospitals.
2 New-born totalled separately.
Estimated days per thousand of population covered by B.C. Hospital Insurance Service:   1949, 1,528;   1950, 1,548;
1951, 1,496;   1952, 1,545;   1953, 1,638.
Table Hb.—Summary of the Number of B.C.H.I.S. In-patients
and Short-stay Patients, 1949-53
1949
1950
1951
19521
1953
Total
Total adults, children, and new-born in-patients
174,269
29,000
178,979
44,502
184,326
47,656
189,871
46,767
208,111
44,342
935,556
212,267
Total receiving benefits 	
203,269
223,481
231,982
236,638
252,453
1,147,823
1 Amended as per final reports received from hospitals. NN 18
BRITISH COLUMBIA
Table III.—Patients Discharged, Total Days' Stay and Average Length of Stay
in B.C. Public Hospitals for B.C.H.I.S. Patients Only, Grouped According
to Bed Capacity, Year 1953.
Bed Capacity
Total
250 and
Over
100 to 249
50 to 99
25 to 49
Under 25
Special
Patients discharged—
169,259
27,033
1,712,494
197,209
10.12
7.30
70,243
9,906
852,600
77,198
12.14
7.79
28,746
4,440
280,053
32,162
9.74
7.24
39,363
8,274
328,006
57,999
8.33
7.01
15,686
2,363
127,379
16,233
8.12
6.87
11,249
1,754
84,535
11,640
7.51
6.64
3,972
296
39,921
New-born	
Patient-days—
1,977
Average days of stay—
10.05
New-born  	
6.68
Table IV.—Percentage Distribution of Patients Discharged and Patient-days
for B.C.H.I.S. Patients Only, in B.C. Public Hospitals, Grouped According
to Bed Capacity, Year 1953.
Bed Capacity
Total
250 and
Over
100 to 249
50 to 99
25 to 49
Under 25
Special
Patients discharged—
Adults and children	
Per Cent
100.00
100.00
100.00
100.00
Per Cent
41.49
36.65
49.79
39.15
Per Cent
16.98
16.42
16.35
16.31
Per Cent
23.26
30.61
19.15
29.41
Per Cent
9.27
8.74
7.44
8.23
Per Cent
6.65
6.49
4.94
5.90
Per Cent
2.35
1.09
Patient-days—
Adults and children  —
2.33
1.00
In Tables III and IV those public hospitals in which B.C. Hospital Insurance Service
does not cover certain types of hospitalization have been shown under the heading
" Special."    The figures, however, include only B.C.H.I.S. patients. HOSPITAL INSURANCE SERVICE REPORT, 1953
NN 19
Principal Causes of Hospitalization, July 1st to December 31st, 1952
Age Group 1 — 0
•  1
Age Group 2 -- 1
• 4
Age Group 3 — 5
• H
Age Group 4 —15
■ 24
Malp     TTpmnlp
Age Group 5
Age Group 6
Age Group
Age Group
7 -
25 - U
A5 - 6i
65 - 69
— 70 and over
Age Group 9 -- Hot Specified
l—i—i—i—i—r
TONSILS & ADENOIDS
1250
1000
750
500
250
0
9000
8000
7000
6000
5000
4000
3000 -
2000
1000
BENIGN & UNSPECIFIED
NEOPLASMS
DELIVERIES
AGE GH0UPS NN 20
BRITISH COLUMBIA
Av. Days'
Stay	
Average Lengths of Stay for Nineteen Major Diagnostic Categories of Illness, ft
July 1st to December 31st, 1952
30
25
20
15
10
Key to Diagnostic Categories
Infective and Parasitic  10 Genito-urinary System
Neoplasms
Allergic, etc.
Blood
Mental
Nervous System
7 Circulatory System
8 Respiratory System
9 -Digestive
11 Deliveries, Pregnancy, etc.
12 Skin
13 Bones
14 Congenital Malformations
15 Early Infancy
16 Symptoms, Senility, etc.
17 Accidents, etc.
18 Live Births
19,-- Impairment due to Birth Injury, etc.
1   2  3   4   5   6   7   8  9  10  11  12  13  14 15  16  17  18 19
Broad Diagnostic Category
ft Based on Manual of the International Statistical Classification of Diseases, Injuries and
Causes of Death, 6th ed., 1948. HOSPITAL INSURANCE SERVICE REPORT,  1953
NN 21
Case Fatality Rate
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1 "
Case Fatality Rates for Nineteen Major Diagnostic Categories of Illness,
July 1st to December 31st, 1952
Key to
Diagnostic Categories
1
Infective & Parasitic
10
Genito-urinary System
2
Neoplasms
11
Deliveries, Pregnancy, etc.
5
Allergic, etc.
12
Skin
4
Blood
13
Bones
5
Mental
H
Congenital Malformations
b
Nervous System
15
Early Infancy
7
Circulatory System
16
Symptoms, Senility, etc.
8
Respiratory System
17
Accidents, etc.
9
Digestive
18
Live Births
19 Impairment due
to Birth Injury, etc.
l        2     ?       4       5       67       8      9     10     11     12     13   14     15     16     17     18   19
Broad Diagnostic Category
k    Based on Manual of the International Statistical Classification of Diseases, Injuries and
Causes of Death, 6th ed-, 1948- NN 22 BRITISH COLUMBIA
STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR THE
FISCAL YEAR ENDED MARCH 3 1st,  1953
Revenue receipts—
Premiums—
General (net)   $14,882,288.84
  $14,882,288.84
Cost of hospitalization re social-assistance cases    $3,546,278.15
Municipal per diem grants   977,136.91
Provincial per diem grants        1,520,171.20
       6,043,586.26
$20,925,875.10
Cash disbursements—
Administration—
Salaries      $ 1,410,974.39
Advisory Council   161.14
Advertising and publicity  28,045.74
Tabulating equipment, rentals, etc.   77,379.32
Automobiles and accessories   6,686.52
Hospital surveys   $8,113.88
Less recovered   13,184.33
  5,070.45
Office supplies and general   126,177.18
Office furniture and equipment  14,769.04
Postage   46,865.84
Rentals and maintenance  79,377.61
Travelling expenses   25,118.01
Upkeep of automobiles  12,591.22
1,823,075.56
Payments to hospitals—claims     21,309,963.72
$23,133,039.28
Excess of disbursements over revenue receipts for the fiscal year ended March 31st,
1953      $2,207,164.18
The Statement of Revenue Receipts and Cash Disbursements for the fiscal year ended March 31st,
1953, together with the Statement Showing Cash Reconciliation with the Public Accounts of the
Province of British Columbia as at March 31st, 1953, show the cash transactions only of the Hospital
Insurance Fund for the period according to the books of the Province.
C. J. FERBER, C.A.,
Comptroller-General, Province of British Columbia. HOSPITAL INSURANCE SERVICE REPORT,  1953
NN 23
STATEMENT SHOWING CASH RECONCILIATION WITH THE PUBLIC ACCOUNTS
OF THE PROVINCE OF BRITISH COLUMBIA AS AT MARCH 31st,  1953
Period ended March 31st, 1949 (Public Accounts, page
215)   $5,305,908.18
Less financed by Provincial loans and grants—
Hospital Insurance Stabilization Fund         $50,000.00
"Amusements Tax Act "     1,445,573.40
1,495,573.40
Operating receipts over disbursements      $3,810,334.78*
Fiscal year ended March 31st, 1950, disbursements over
receipts (Public Accounts, page 147)   $4,550,580.32
Add financed by Provincial loans and grants—
Hospital Insurance Stabilization Fund   $1,950,000.00
" Revenue Surplus Appropriation Act, 1950 "     2,500,000.00
$4,450,000.00
'Amusements Tax Act " (fiscal
year 1949, above)     1,445,573.40
3,004,426.60
Operating disbursements over receipts        7,555,006.92
Fiscal  year ended  March   31st,   1951,  disbursements  over  receipts
(Public Accounts, page 144)        5,118,697.76
Fiscal  year  ended  March  31st,   1952,  receipts  over  disbursements
(Public Accounts, page 99)   46,321.32*
Fiscal  year  ended  March  31st,   1953,  disbursements  over receipts
(Public Accounts, page 99)        2,207,164.18
Operating disbursements over receipts, 1949-53   $11,024,212.76
Add balance at March 31st, 1953—
Amount adjusted on advances to hospitals .... $2,508,482.01t
Credit balance, Hospital Insurance Fund     7,216,955.25
Financed by Provincial loans and grants—
Hospital Insurance Stabilization Fund—
Public Accounts, 1948-49, page 210
$50,000.00
4,708,473.24
$15,732,686.00
Public Accounts, 1949-50, page 134       1,950,000.00
$2,000,000.00
"Revenue Surplus Appropriation Act, 1950" (Public Accounts,
1949-50, page 134)   2,500,000.00
Amount voted under Vote 118, 1950-51   2,545,696.00
"Revenue Surplus Appropriation Act, 1951 " (Public Accounts,
1950-51, page 144)   1,500,000.00
Amount voted under Vote 124, 1951-52  2,500,000.00
Amount voted under Vote 124, 1952-53   4,686,990.00
15,732,686.00
Credits.
t 1950-51 credits, $1,934,062.62;   1951-52 credits, $618,740.95;   1952-53 debit, $44,321.56. NN 24 BRITISH COLUMBIA '".~3
BENEFITS IN B.C. HOSPITALS,  1953
The general hospital services to be provided shall include such of the following
services as are recommended by the attending physician, and as are available in the
hospital to which the person is admitted as an in-patient, and when there is definite
medical necessity for in-patient care: —
(a) Public-ward accommodation:
(b) Operating-room facilities, including the use of all equipment and material
required in the proper care of surgical cases:
(c) Case-room facilities, including the use of all equipment and material
required in the proper care of maternity cases:
(d) Surgical dressings and casts as required, as well as other surgical materials
and the use of any equipment which may be required while in hospital:
(e) Anaesthetic supplies and the use of anaesthesia equipment:
(/) All other services rendered by individuals who receive any remuneration
from the hospital, provided that the provision of such services in a particular hospital is approved by the Commissioner. Services which may
be approved by the Commissioner for the purpose of this section may
include:—
(1) Radiological, diagnostic, and therapeutic services, including the
services of a radiologist:
(2) Clinical laboratory and other diagnostic procedures, including
the services of a pathologist:
(3) Physiotherapy services:
(g) Care of the acute stage of chronic diseases where, in the opinion of the
Commissioner, such care is necessary and desirable. Such chronic
disease shall include cardiac disease, tuberculosis, mental disease, and
acute anterior poliomyelitis; the acute stage of venereal disease only where
general hospital care is recommended by the Division of Venereal Disease
Control; the acute stage of drug addiction where overdosage and poisoning have to be given prompt treatment; and the acute stage of alcoholism,
provided in the case of acute alcoholism that hospitals establish under
their own by-laws the conditions under which such persons may be
admitted to hospital:
(h) Such drugs and related preparations listed in the British Columbia Formulary and such other preparations as the Commissioner may from time to
time prescribe.
BENEFITS IN HOSPITALS OUTSIDE BRITISH COLUMBIA
Payments for hospital services rendered by hospitals outside the Province of British
Columbia to persons who are beneficiaries under the Act shall be made on the basis of
not more than $8 per day (new-born, $3.50 per day) and for a period of time not to
exceed thirty days. Payments for a longer period of time than thirty days may be
authorized by the Commissioner where he is satisfied that further care of a type provided
for under the Act is required.
Where a beneficiary produces receipts showing that he has himself paid an account
to a hospital situated outside the Province, he may be reimbursed within the limitations
and subject to the conditions provided in the regulations under the Act.
CLASSES OF PERSONS COVERED BY OR EXCLUDED FROM THE
BENEFITS OF THE HOSPITAL INSURANCE SERVICE
A. Covered by the Plan upon Payment of the Required Premium
Every person who is a resident of the Province, except persons classified in Groups
B, C, and D hereunder.   Participation in the plan is compulsory, except for those in the
far northern areas, who may voluntarily pay premiums and be entitled to benefits. HOSPITAL INSURANCE SERVICE REPORT,  1953 NN 25
B. Covered by the Plan by the Provincial Government
Those persons who are in receipt of any form of social assistance to which the
Provincial Government of British Columbia contributes financially and who, in addition,
have been certified by the Deputy Minister of Welfare to be persons entitled to free
health services.
C. Persons Entitled to Claim Exemption
1. Members of the Canadian Armed Forces (but not their dependents).
2. Members of the Royal Canadian Mounted Police (but not their dependents).
3. Students in training under the Department of Veterans' Affairs (but not their
dependents).
4. Veterans in receipt of war veterans' allowance (but not their dependents).
5. Members of the Christian Science Church.
6. Persons resident in certain far northern regions of the Province which have no
hospital facilities. Such persons, if they pay premiums voluntarily, are entitled to the
benefits under the Act in any acute general hospital in the Province.
7. Members of the Canadian Pacific Employees' Medical Association of British Columbia and the Telephone Employees' Medical Services Association of British Columbia.
8. Persons covered by the Saskatchewan Hospital Services Plan.
D. Persons Excluded from the Plan
1. A person who is a patient or an inmate of an institution maintained by the
Province.
2. Persons in the Provincial tuberculosis sanatorium.
3. Persons committed to a gaol or penitentiary.
TABLE V.—CLAIMS FOR EXEMPTION
Claims Approved Total Exemptions
during 1953 at Dec. 31, 1953
Old-age pension, blind pension, Old Age
Security bonus,  mother's  allowance,
and social assistance  6,574 27,171
W.V.A. and Class 6 patients, and D.V.A.
students     814 1,370
Royal Canadian Mounted Police  148 1,027
Exempted area   93 355
Prisons   27 124
Armed Forces  1,439 8,250
Church of Christ, Scientist  75 1,660
Saskatchewan Hospital Services Plan  295 71
Provincial institutions—tuberculosis, mental, and infirmaries  748 1,516
General   111 186
Canadian Pacific Employees' Medical Association of British Columbia  4,433 14,000
Telephone   Employees'   Medical   Services
Association of British Columbia  1,403 4,347
Totals  16,160 60,077
Note.—A large number of persons in receipt of social allowance have not registered with the B.C. Hospital Insurance Service. NN 26 BRITISH COLUMBIA
Claims granted retroactively for various periods  2,549
Approved claims cancelled   11,343
New claims refused  758
Adjustments to existing claims  14,123
Adjustments to medical identity cards   14,107
Hospital claims received for approval  32,506
Medical identity cards received  10,663
Refunds approved   4,510
Claims for Dependency
Approved    2,09 8
Not approved  57
Reviewed and reapproved  15
Reviewed and not approved  2
Claims cancelled  9
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1954
500-454-8530