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Seventh Annual Report British Columbia Hospital Insurance Service JANUARY 1ST TO DECEMBER 31ST 1955 British Columbia. Legislative Assembly 1956

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 PROVINCE OF BRITISH COLUMBIA
"HOSPITAL INSURANCE ACT"
Seventh Annual Report
British Columbia Hospital
Insurance Service
JANUARY 1st TO DECEMBER 3 1st
1955
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1956  Victoria, B.C., January 17th, 1956.
To His Honour Frank Mackenzie Ross, C.M.G., M.C.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
The undersigned has the honour to present the Seventh Annual Report of the British
Columbia Hospital Insurance Service covering the calendar year 1955.
E. C. MARTIN,
Minister of Health and Welfare. British Columbia Hospital Insurance Service,
Victoria, B.C., January 17th, 1956.
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 British Columbia
Hospital Insurance Service covering the calendar year 1955.
D. M. COX, F.A.C.H.A.,
Commissioner, British Columbia Hospital
Insurance Service. CONTENTS
Page
General Introduction  7
Financial (a)—
Revenue  7
Financial (b)—
Claims and Accounting  7
Methods of Payment to Hospitals  8
Hospital Services   9
Organization and Administration-—
Administrative Assistant  9
Organization Chart  10
Eligibility Section  11
General Office  11
Research Division _— 11
Hospital Services Group—
Hospital Finance Division—
Hospital Claims Section  12
Hospital Accounting Section  13
Hospital Construction Division  13
Hospital Consultation and Inspection Division—
Victoria Office  14
Vancouver Office  15
Medical Consultation Division  16
Benefits in British Columbia Hospitals, 1955  16
Emergency or Short-stay Care  17
Benefits in Hospitals outside British Columbia   17
Classes of Persons Entitled to or Excluded from the Benefits of the " Hospital Insurance Act"—
A. Entitled to Benefits   17
B. Excluded from Benefits  17
General Hospital Care   18
Table I. — Patients Discharged and Days of Care in British Columbia Public
Hospitals, 1949-55, and Proportion Covered by British Columbia Hospital
Insurance Service  19
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, 1949-55  20
Table IIb.—Summary of the Number of B.C.H.I.S. In-patients and Short-stay
Patients, 1949-55  20
Table III.—Patients Discharged, Total Days' Stay, and Average Length of Stay
in British Columbia Public Hospitals for B.C.H.I.S. Patients Only, Grouped
according to Bed Capacity, Year 1955  21
Table IV.—Percentage Distribution of Patients Discharged and Patient-days for
B.C.H.I.S. Patients Only, in British Columbia Public Hospitals, Grouped
according to Bed Capacity, Year 1955  21 Z 6 BRITISH COLUMBIA
Graphs—
Appendicitis, Neoplasms, and Tonsils and Adenoids, Which Were among the
Leading Causes of Hospitalization in British Columbia in 1954, by Age of
Patients and Length of Stay  22
Arteriosclerotic Heart Disease, Pneumonia, and Deliveries, Which Were among
the Leading Causes of Hospitalization in British Columbia in 1954, by Age
of Patients and Length of Stay  23
Percentage Distribution of Admission and Patient-days by Major Diagnostic
Categories of Illness, 1954  24-25
Average Length of Stay of Persons Hospitalized in British Columbia by Major
Diagnostic Categories, 1954  26
Case Fatality Rates per 100 Patients Hospitalized in British Columbia by Major
Diagnostic Categories, 1954  27
Statement of Receipts and Disbursements for the Fiscal Year Ended March 31st, 1955
  28-29
Approved Hospitals in British Columbia  30 Seventh Annual Report of the British Columbia
Hospital Insurance Service
GENERAL INTRODUCTION
The British Columbia Hospital Insurance Service completed seven years of operation
on December 31st, 1955. The programme was established as a protective measure and
has two main objectives—to protect residents of the Province from the financial burden
associated with hospitalization and to protect hospitals of the Province from non-
collectable accounts, which had ranged as high as 55 per cent. During 1955 approximately 93 per cent of all patients admitted to British Columbia acute-care general hospitals
had coverage with the Service.
When the Service first commenced operations, eligibility for benefits was dependent
upon premium payment under certain specified conditions. Effective April 1st, 1954,
the premium-payment plan was terminated and residency became the determining factor
for eligibility. This new concept made benefits available to qualified residents (see
Classes of Persons Entitled to or Excluded from the Benefits of the " Hospital Insurance
Act," page 17). All persons eligible for benefits receive comprehensive protection against
the expense of acute in-patient care by being provided with substantially all of the
hospital's services. Benefits consist of payment at the standard public-ward level for
treatment that can be obtained only in an acute-care general hospital, payments for
emergency treatment (short-stay benefits), and payments for treatment in hospitals outside British Columbia (out-of-Province benefits). For details on benefits refer to page
16. Persons receiving hospital insurance benefits in British Columbia are required to pay
$1 for each day's coverage by the Service.
The two main functions of the Hospital Insurance Service are Financial and Hospital
Services.
Financial (a)
Revenue
Government funds for the operation of the Hospital Insurance Service and all Provincial Government social welfare services are provided by a 5-per-cent social services
tax. Another source of revenue for the Hospital Insurance Service is Provincial and
municipal per diem grants. The Provincial Government pays the Hospital Insurance
Service 70 cents for each day's treatment in acute-care general hospitals in British
Columbia. City and district municipalities pay 70 cents for each day's treatment provided
to those persons defined as " municipal residents " under section 32 of the " Hospital Act."
When admitted to an acute-care general hospital, a patient wishing coverage with
the Hospital Insurance Service is required to complete an application for benefits. The
hospital is responsible for verifying the statements regarding length of residence, to
determine if the patient is a resident as defined under the Act and regulations. Payment
of the account is then requested from the Hospital Insurance Service, which reserves the
right to reject any account where statements regarding residence do not meet requirements.    (See Eligibility Section, page 11.)
Financial (b)
Claims and Accounting
The second part of the financial function of the Service is hospital payments.
Payment of qualified patients' hospital expenses is calculated on the basis of per diem
rates established under the budget system see page 8. Z 8
BRITISH COLUMBIA
Methods of Payment to Hospitals
A system of firm budgets for hospitals was introduced effective January 1st, 1951,
providing for a review of hospitals' estimates by the Rate Board of the Hospital Insurance
Service. Hospitals were advised they would be required to operate within their approved
budgets, with the exception of fluctuation in days' treatment and other similar items.
They were further advised that deficits incurred through expenditures in excess of the
approved budget would not be met by the Provincial Government. The value of variable
supplies used in patient-care was calculated. When the number of days' treatment
provided by the hospital differed from the estimate, the budgets were subject to the
number of days' difference multiplied by the patient-day value of the variable supplies.
Individual studies were made in those instances where large fluctuations in occupancy
involved additions or reductions in stand-by costs, and budget adjustments were made.
The firm budget procedure was followed in 1955; however, hospital budgets were
established on the basis of 1954 salary rates plus increments within salary ranges previously in effect in hospitals, rather than on 1955 rates where hospitals granted salary
increases for 1955.
The majority of hospital accounts are the responsibility of the British Columbia
Hospital Insurance Service (a small percentage are Workmen's Compensation recipients,
non-qualified residents, etc.), and the Service pays each hospital monthly the proportion
of one-twelfth of the yearly budget represented by B.C.H.I.S. insured days, as compared
to the total days' treatment. By the month's end each hospital is advanced the approximate amount required to cover B.C.H.I.S. patients, including those remaining in hospital
at the end of the month. Qualified patients are charged $1 per day, which is deductible
when calculating payments due hospitals from the Service. Non-qualified residents are
charged the hospitals' established per diem rates.
In 1955 approximately 93 per cent of all patients were covered by the Service. This
compares with an average of approximately 85 per cent coverage experienced prior to the
introduction of new policies on April 1st, 1954.
Hospital Rate Board: Mr. J. M. Mainguy, M.H.A., Manager, Hospital Consultation
and Inspection Division; Mr. D. M. Cox, F.A.C.H.A., Commissioner; and Mr. W. J. Lyle,
Manager, Hospital Finance Division. hospital insurance service report, 1955 z 9
Hospital Services
The second main function of the Hospital Insurance Service is maintaining high
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: To assist hospitals in problems dealing with accounting,
finance, and the purchase of equipment, and to review hospital accounting
and financial records.
Hospital Consultation and Inspection: To advise hospitals on problems of an
administrative or operational nature, and to ensure that proper standards
of patient-care are maintained.
Medical Consultation: To check all hospital accounts before passing for payment, to supply technical knowledge to all divisions, and to review medical
policies and regulations under the advice and guidance of the Medical
Review Board.
Hospital Construction: To render an advisory service to hospitals planning
construction and improvements and to process applications for construction grants.
Research: To conduct studies relating to hospital occupancy, and to prepare
medical and financial information pertaining to the hospital bed requirements of the Province.
Administrative Assistant: To assist in the formation of hospital districts in
areas where no municipal organization exists, and to give guidance in the
review of hospital by-laws and related problems.
ORGANIZATION AND ADMINISTRATION
Administrative Assistant
The Administrative Assistant's office is responsible for the preparation of legislation,
regulations, and Orders in Council, and therefore maintains a close liaison with the
Attorney-General's Department. It is also responsible for providing a uniform interpretation of the various Acts and regulations to the other divisions of the Hospital Insurance
Service.
In conjunction with the Hospital Consultation and Inspection Division, hospital
by-laws are reviewed and revised for the purpose of bringing them to the stage where
Government approval may be obtained. A set of model by-laws for use as a guide in
making revisions is available to hospitals. In 1955 a new and larger edition containing
many explanatory notes was published. Advice and assistance is available to hospitals
in regard to problems connected with by-laws and their application.
This office also works in conjunction with the Water Rights Branch in assisting
communities in unorganized territory to establish hospital improvement districts. Circulars describing the procedure for establishing such a district and the purposes the district
serves may be obtained from the Administrative Assistant.
The Hospitalization Reports that are completed by hospitals for every patient
admitted with accidental injuries are processed by this office, which also handles the
arrangements under which British Columbia Hospital Insurance Service receives reimbursement from public liability insurance companies and self-insured corporations for
hospital bills paid by this Service on behalf of accident victims. Z 10
BRITISH COLUMBIA
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Eligibility Section
In order to ensure that only those applicants who qualify, in accordance with the Act
and regulations, receive benefits, field representatives review and audit all Applications for
Benefits. Representatives are located in Victoria, Vancouver, Prince George, Kelowna,
Kamloops, and Nelson.
General Office
This office is responsible for the general administration of all receipts and expenditures incurred in the operation of the Service. It also has custody and control of all
records which were maintained, prior to reorganization of the Service in April, 1954, by
the former Payroll and Central Accounts Divisions and Revenue Control. Personnel and
staff payroll duties are included in its responsibilities.
The general office administers the requisitioning and inventory of supplies, furniture,
and equipment, and handles mail distribution to and from the various offices. A duplicating service is operated for internal use, and a teletype service is maintained between
Victoria and Vancouver for use by all Civil Service offices in the Victoria and Greater
Vancouver areas.
Public relations duties included editing instructional circulars distributed to all
acute-care hospitals, printing information of a general nature intended for public use,
and preparation of the Seventh Annual Report. A library of 16-mm. sound film of an
educational nature is also maintained for the use of hospital staffs and other interested
groups.
Research Division
The three main functions of this Division are as follows:—
(1) To tabulate, compile, and analyse morbidity statistics from data found in
the admission-discharge records forwarded to the Service from British
Columbia acute-care hospitals for all in-patients.
(2) To study geographic areas within the Province relative to determining the
need and size of new hospital construction.
(3) To assist the administration and other agencies with compilations of data
which are not directly available from other divisions within the Service.
In discharging the first function during 1955, a detailed study entitled "Morbidity
in British Columbia Hospitals " was completed and published in July. This report
revealed the occurrence by age and sex of those conditions listed in the Manual of the
International Statistical Classification of Diseases, Injuries, and Causes of Death in
institutions providing general hospital services in the Province. Incidence of hospitalization by geographic area and institutional size were also presented.
Four reports dealing with hospital bed requirements for acute care in ten school
districts were also completed. These studies covered Trail-Nelson-Castlegar, Dawson
Creek-Fort St. John-Pouce Coupe, Burns Lake-Vanderhoof-Prince George, and Campbell
River. Each report was compiled from comprehensive study of the population size and
characteristics, access to existing hospital centres, climatological factors, sources of
income, and potential development, in addition to the analysis of previous and existing
incidence of hospitalization.
A regional survey of Vancouver Island which has been designed to determine the
quantity and location of additional hospital facilities was also commenced. Fifteen
organized and twelve unorganized school districts will be reviewed before analysis is
attempted in this project.
In addition to the planning of tabulation runs for the above-mentioned surveys,
outlines of tabulation requirements dealing with hospital insurance material were drafted
for use in the British Columbia submission to the Federal-Provincial Conference. Z  12
BRITISH COLUMBIA
Special statistical series and compilations were also initiated for the information of
the Department of National Health and Welfare, the Indian Affairs Branch of the Department of Citizenship and Immigration, and the Royal Commission on Canada's Economic
Prospects.
A second edition of the Geographical Listing of British Columbia was prepared to
enable more accurate coding of the residence location of Indians.
Study of the causes of variation in average periods of hospitalization was also continued during the year.
Hospital Services Group
Hospital Finance Division
Hospital Claims Section.—The main responsibilities of this Section are to screen
patients' Applications for Benefits and to authorize the payment of hospital accounts.
The number of accounts paid by this Service has continued to increase. During the
year 241,873 accounts have been paid, as compared to 229,735 in 1954 and 208,530
in 1953. Included in the year's total were 2,150 out-of-Province accounts paid on
behalf of qualified persons admitted to hospitals in other Provinces of Canada, the United
States, Central America, Hawaii, Europe, and Australia. Approximately 1,000 admission
notices were received each working-day and screened for diagnosis in conjunction with
the Medical Consultation Division. An equivalent number of hospital accounts were
also checked for statistical data and for B.C.H.I.S. responsibility.
Applications for Benefits are checked individually before the account is approved
for payment. In many cases, applications are referred to the field representatives of
the Eligibility Section for further investigation, where necessary.
This Section also administers the billing and collection of municipal per diem grants,
and individual hospital accounts are checked to determine the municipality responsible.
During this year approximately $1,055,000 was collected through municipal per diem
grants.
Hospital Claims Section. This Section receives approximately 1,000 hospital admission notices daily. An equivalent number of hospital accounts are checked for B.C.H.I.S.
responsibility. HOSPITAL INSURANCE SERVICE REPORT,  1955 Z 13
An alphabetical file is maintained of all recipients of Social Welfare assistance in the
Province of British Columbia. All hospital accounts incurred by Social Welfare patients
are checked against the file in order to determine eligibility for the dollar-a-day charge
(see page 7). Information relative to the medical identity numbers allotted to recipients
is given upon request to Welfare Department authorities and doctors' offices.
A Key-punch Section is responsible for punching I.B.M. punch-cards which record
the financial, statistical, and medical data shown on each discharge record. An average
of 1,200 cards were punched daily and used to provide listings of accounts paid to hospitals, listings of individual charges payable by municipalities in respect to per diem
grants, and to provide the statistical data required by the Research Division.
Patients' records for the previous year were again microfilmed by the Central
Microfilm Bureau of the Provincial Library. Over 740,000 documents were processed,
using 23,600 feet of film.   This work was completed over a period of three months.
Hospital Accounting Section.—Primarily concerned with hospital budgets, this
Section maintains close working relationships with hospitals. Frequent inspections are
made of hospital financial, statistical, and accounting records. When smaller hospitals
require accounting assistance, this Section, upon request, provides accounting aid and
instruction.
This Section also checks and amends financial and statistical reports prepared by
hospitals for the Dominion Bureau of Statistics; studies and recommends for approval
requests made by hospitals for payment of grants in connection with capital expenditures
for equipment; audits accounts relating to hospital construction projects, in collaboration
with Federal Treasury officials; carries out accounting studies in nursing homes and
chronic hospitals, at the request of the Provincial Social Welfare Branch, to assist in
establishing rates to be paid for the care of Social Welfare patients; collates with the
approved budget statistical reports and revenue and expenditure statements received from
hospitals on a monthly basis; calculates cash advances forwarded to hospitals semimonthly.
This Section prepared the Annual Report on Hospital Statistics for 1954.
Hospital Construction Division
The primary function of this Division is to recommend for approval grants-in-aid
for capital construction and improvements, other than equipment.
This Division also provides a consultation service to hospitals, hospital societies or
groups, contemplating either new hospital construction, improvements to existing buildings, major additions, or reconstruction. Close liaison is maintained with Federal
authorities in order to ensure that Federal standards of construction are met and that
maximum Federal assistance may be obtained for the project.
Reference material on planning and hospital designing and information on the cost
of hospitals built since the inception of the Hospital Insurance Service, are available on
request. Proposed site locations are inspected when possible, and assistance is provided
to hospital planning groups in the appraisal of sites.
Matters pertaining to sanitation and nutrition are referred to the Provincial Health
Branch.
The following is a list of projects that were completed during the year 1955:—
(1) Quesnel General Hospital, Quesnel—replacement of existing hospital and
construction of a nurses' residence, resulting in 47 new active-treatment
beds, 3 recovery beds, 1 labour bed, 17 bassinets, and 16 nurses' beds.
(2) Bulkley Valley District Hospital, Smithers—construction of an addition
to the existing building;  net gain in beds, 39.
(3) St. Paul's Hospital, Vancouver—construction of an addition to the nurses'
home, which included 87 nurses' beds.   Additional operating-rooms were Z 14 BRITISH COLUMBIA
also included in the new addition to the hospital, as well as a main kitchen
and a nurses' dining-room, together with 14 post-operative recovery beds.
(4) St. Vincent's Hospital, Vancouver—construction of new main building
addition to existing hospital; net gain in beds, 136, plus 6 recovery beds
and 26 bassinets.
(5) Skidegate Inlet General Hospital, Queen Charlotte City—construction of
new hospital building, replacing the old hospital. New beds, 20; labour
bed, 1;  bassinets, 8;  nurses' beds, 8.
(6) Golden General Hospital, Golden—construction of nurses' residence,
which provided accommodation for 8 nurses.
(7) Vancouver General Hospital, Vancouver—addition to radiology department.
(8) Lady Minto Hospital, Ashcroft—construction of an addition and alterations to provide 14 beds and an operating and delivery theatre.
(9) War Memorial Hospital, Williams Lake—extension of existing hospital
to provide a net gain of 11 beds and 5 bassinets.
In 1955, construction was also commenced on the following projects:—
(1) 504-bed acute unit at the Vancouver General Hospital.
(2) 20-bed hospital at Invermere.
(3) Addition to the Mount St. Joseph's Hospital, Vancouver, to provide
33 additional active-treatment beds, 24 chronic beds, and 9 nurses' beds.
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St. Mary's Hospital, New Westminster, B.C. (architect's drawing).    Construction on this
new hospital commenced in December, 1955.
Hospital Consultation and Inspection Division
Victoria Office.—Hospital inspection and administrative assistance are regarded as
the main functions of this office. It also plays a part in the financial arrangements between
the Hospital Insurance Service and the public hospitals. The Division is represented on
the Hospital Rate Board. During 1955 there was emphasis on work connected with hospital estimates and on intensive surveys of the operation of individual hospitals. Much of
the work was carried on in conjunction with the Hospital Finance Division. Administrative assistance in respect to particular problems was given to numerous hospitals, in many
instances by a direct visit by one of the staff.
Many hospitals requested intensive surveys, and the staff was able to complete seven
of these.    The surveys involved more than one staff member and required a period of
J HOSPITAL INSURANCE SERVICE REPORT,  1955 Z 15
from seven to thirteen days at each hospital surveyed. As a result of these intensive
surveys, and because of fewer staff, regular inspections of general hospitals were reduced
in number from previous years.
This office continued its work of processing draft by-laws of hospital societies in
conjunction with the Administrative Assistant. Reviews of complete revisions for
eighteen societies were handled, as well as numerous amendments. A new set of model
by-laws was made available by the Service during the year. Reference material was
also provided to hospitals whose medical staffs were active in reviewing their by-laws.
Information on personnel matters was distributed to hospitals.
The office assisted other divisions of the Service in such matters as reviews of
hospital plans, requests for equipment grants, and surveys of hospital bed requirements.
Health Branch nutrition consultants and the newly appointed technical supervisor
(clinical laboratory services) worked closely with the office in connection with hospital
problems. As in the past, liaison was maintained with hospitals and the Health Branch
in the reporting and follow-up of staphylococcal and other infections in hospitals. Instructions were given to hospitals regarding recording and reporting of infections.
Vancouver Office.—The activities of this office are primarily directed to hospital
clearance and to the licensing and inspection of private hospitals, most of which are of
a type often referred to as " nursing homes." However, the office is becoming increasingly active in consulting with clients and architects on plans for new private hospitals.
The office is a clearing-house for questions of all types relating to the care of patients.
Hospital clearance is the process by which suitable placement is found for patients
in general hospitals who no longer need the specialized services of such hospitals but
who do need some form of care. Most hospitals in the Province do not have a social
service department, and so it falls upon the Social Welfare Branch, through its field service
staff, to assist in finding placement for such problem cases. During 1955 there were
151 referrals by general hospitals throughout the Province asking for help in the removal
of such cases. These were in turn referred to the field staff of the Social Welfare Branch
for action. Eleven referrals were received which did not require the services of Welfare
and did not constitute true hospital clearance cases. Eighty-six inquiries were made
regarding the establishment of private hospitals. Three private hospitals closed and six
were opened.
An annual visit was made to the private hospitals. Such inspections are conceived
to be something more than seeing the physical plant, equipment, the housekeeping, and
provisions for safety. The inspector is also interested in the quality and spirit of owners
and personnel and the condition of patients and their reaction to the care they receive.
Several complaints were received with respect to the operation of private hospitals.
These were thoroughly investigated.
Many private hospitals sought advice for improving conditions and service facilities.
Many improvements were instituted. In some instances diversional and recreational
programmes were established.
At December 31st, 1955, there were fifty-six licensed private hospitals in operation.
These hospitals varied in size from 2-bed facilities to some with more than 85 beds. The
average facility had 18 to 20 patients. Altogether, beds in private hospitals totaled
1,371 beds. This included 170 beds in private acute-care general hospitals, most of
which were established by mining or other industrial concerns.
There was an increasing interest in constructing new buildings with the very latest
ideas for chronic care. At the year-end eight new private hospitals were being constructed. Other plans were on the drawing-boards and under discussion. The improvement in the standard of care is most gratifying. However, the emphasis must still be
placed on adding " life to the patients' years, not just years to their life." Z 16 BRITISH COLUMBIA
Medical Consultation Division
The main function of the Medical Consultant and his staff is to review all admission
and discharge records from the standpoint of medical qualification before passing them
for payment. This Division also provides a source of technical knowledge for use by all
branches of the Service.
Hospital claims are checked for length of stay, and particular attention is given the
claims of chronic and short-stay patients. Out-of-Province claims are reviewed and
the hospitals concerned checked to ensure they meet the required standards.
The Medical Consultant and the Commissioner represent the Hospital Insurance
Service on the Medical Review Board which, by its advice and guidance, helps maintain
good relationships among the Service, the medical profession, and the hospitals. The
remaining three members of the Board are physicians designated by the College of
Physicians and Surgeons of British Columbia.
A further responsibility of the Division entails a careful study of discharge diagnoses
which are coded in accordance with the Manual of International Statistical Classification
of Diseases, Injuries, and Causes of Death.
BENEFITS IN BRITISH COLUMBIA HOSPITALS, 1955
The general hospital services, to be provided to a qualified person pursuant to the
Act, shall include such of the following services as are recommended by the attending
physician and as are available in or through the hospital to which the person is admitted
as an in-patient:—
(a)  Public-ward accommodation:
(_>) 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:
(/) Such drugs, prescriptions, and similar preparations as may be designated
by the Commissioner from time to time:
(g) 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 clause may
include:—•
(i) Radiological, diagnostic, and therapeutic services, including the
services of a radiologist:
(ii) Clinical laboratory and other diagnostic procedures, including
the services of a pathologist:
(iii)  The services of an anaesthetist:
(iv)  Physiotherapy services:
(h) Care of the acute stage of chronic diseases where, in the opinion of the
Commissioner, such care is necessary and desirable. Such chronic
diseases 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 HOSPITAL INSURANCE SERVICE REPORT,  1955 Z 17
their own by-laws the conditions under which such persons may be
admitted to hospital.
Emergency or Short-stay Care
Limited B.C.H.I.S. benefits are extended, in British Columbia hospitals only, in
addition to the in-patient benefits available to qualified residents and dependents. These
services include emergency treatment rendered within twenty-four hours of being injured
and operating-room or emergency-room services for minor surgery which does not require
admission to hospital as an in-patient.   The hospital charges $2 for each visit.
BENEFITS IN HOSPITALS OUTSIDE BRITISH COLUMBIA
Provided a beneficiary has not been absent from British Columbia in excess of three
months, he is entitled to payment made on his behalf at a rate fixed by the Commissioner,
in relation to the public-ward charge made by the hospital. Payment from the Hospital
Insurance Service is made only to hospitals approved by the Commissioner, and shall not
exceed $3.50 per day for new-borns and $8 per day for other beneficiaries, for a period
of time determined by the Commissioner, and in any event not exceeding thirty days unless
authorized by the Minister of Health and Welfare.
CLASSES OF PERSONS ENTITLED TO OR EXCLUDED FROM THE
BENEFITS OF THE "HOSPITAL INSURANCE ACT"
A. Entitled to Benefits
A person is considered entitled to benefits if he qualifies as a " resident of the Province " under the " Hospital Insurance Act." Generally speaking, a person is qualified if
he proves to the satisfaction of the Hospital Insurance Commissioner that:—
(a) He is the head of a family or a single person who is living within the Province and has lived continuously therein during the preceeding twelve consecutive months; or
(_>) Having been qualified under item (a), he leaves the Province and returns
after an absence of less than twelve months and resumes residence within
the Province; or
(c) He is living within the Province and is a dependent of a resident of the
Province; or
(d) He is a person who has been certified by the Deputy Minister of Welfare
to be a person entitled to health services.
During the one-year residence qualification period a person is permitted to be
temporarily absent from British Columbia for a total of less than three months without
suffering any postponement of the date on which he becomes a qualified resident.
With regard to item (c) above, a dependent is either the spouse of the head of a
family or a child under 21 years of age who is mainly supported by the head of a family.
If a man's wife and dependent children arrive in British Columbia after he does,
they are entitled to assume his residental status as of the date of their arrival.
B. Excluded from Benefits
Some of the main classes of persons either permanently or temporarily excluded from
benefits are as follows:—
(a) A person who works full or part time in British Columbia but who resides
outside the Province:
(b) A resident who leaves British Columbia and fails to return and re-establish
residence within twelve months; or Z 18 BRITISH COLUMBIA
(c) A patient or inmate of a Provincial or Federal institution, or a person
committed to a gaol or penitentiary; or
(d) A person in a Provincial tuberculosis sanatorium; or
(e) A resident who receives hospital treatment provided under the " Workmen's Compensation Act" or the " Canada Shipping Act," or a war
veteran who receives treatment for a pensionable disability; or
(/) Persons entitled to receive hospital treatment from the Government of
Canada, or any other government; e.g., members of the armed forces, etc.
GENERAL HOSPITAL CARE
Statistical data compiled by the Hospital Finance Division are presented in the tables
on the following pages. The data deal with the volume of hospital care provided to the
people of British Columbia through the Hospital Insurance Service. Eighty-one general
hospitals were approved to accept B.C.H.I.S. patients. In addition, a proportion of care
was given in Red Cross outpost units, veterans' hospitals in Victoria and Vancouver,
private hospitals, and in company-operated hospitals in remote areas.
Data for the year 1955 have been prepared from preliminary unrevised reports
submitted by hospitals, and consequently are subject to minor revision.
The average length of stay of B.C.H.I.S. adult and children patients in British
Columbia general hospitals decreased from 10.3 days in 1954 to 10.04 days in 1955.
Total adult and children days covered by the Service in British Columbia general hospitals
during 1955 was 2,012,303, an increase of 57,480 or approximately 3 per cent over 1954.
During 1955 a total of 200,510 B.C.H.I.S. adult and children patients were discharged from British Columbia public hospitals, an increase of 10,797 or approximately
5.7 per cent over 1954. The number of admissions shows a progressive increase at a rate
faster than the increase in population.
On pages 22 to 27 graphs, prepared by the Research Division of the British Columbia
Hospital Insurance Service, depict data compiled from the individual admission-discharge
record received for each person hospitalized for acute care in British Columbia during
1954. HOSPITAL INSURANCE SERVICE REPORT,  1955
Z 19
Table I.—Patients Discharged and Days of Care in British Columbia General
Hospitals, 1949-55, and Proportion Covered by British Columbia Hospital
Insurance Service.
Total Hospitalized
Covered by B.C.H.I.S.1
Adults and
Children
New-born
Total
Adults and
Children
New-born
Total2
Patients discharged—
1949                	
164,964
172,645
181,160
188,355
200,893
206,992
217,274
26,272
26,205
27,096
28,675
30,712
31,984
31,951
191,236
198,850
208,256
217,030
231,605
238,976
249,225
140,168
144,959
150,116
154,336
169.167
24,640
23,943
24,172
25,023
27.830
164,808
1950  	
1951..                                        	
168,902
174,288
1952  —	
1953..                                            	
179,359
196,997
19543 	
189,713    |      29,483
200.510    1      30.283
219,196
1955*              	
230,793
Percentage of total, patients discharged—
1949
84.9
84.0
82.9
81.9
84.2
91.7
92.3
1,430,646
1,476,615
1,467,102
1.569.974
93.8
91.4
89.2
87.3
90.6
92.2
94.8
200,585
193,307
187,891
184.160
86.2
1950
84.9
1951
83.7
1952
82.6
1953.
85.1
19543
91.7
1955*                                   	
92.6
Patient-days—
1949  .-	
1950  	
1951 	
1952.                       	
1,682,196
1,766,680
1,795,438
1,916,486
2,041,615
2,162,002
2,201,696
213,874
212,979
214,285
214,701
220,208
226,031
227,092
1,896,070
1,979,659
2,009,723
2,131,187
2,261,823
2,388,033
2,428,788
1,631,231
1,669,922
1,654,993
1,754,134
1953   	
1.712.878    1    197.100
1,909,978
19543	
1,954,823
2,012,303
85.0
83.6
81.7
81.9
83.9
90.4
91.4
213,587
212,510
93.8
90.8
87.7
85.8
89.5
94.5
93.6
2,168,410
1955*    	
Percentage of total, patient-days—
1949  	
2,224,813
86.0
1950    	
84 4
1951   	
82.3
1952             	
     |     .
82.3
1953               	
      [     .
84 4
19543 	
 _    |     .
90 8
1955*      	
     1
91.6
1                      1
1 British Columbia Hospital Insurance Service excludes Workmen's Compensation Board patients and days.
2 New-born total included.
3 Amended as per final reports received from hospitals,
4 Estimated, based on hospital reports to November 30th, 1955. Z 20
BRITISH COLUMBIA
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, 1949-55.
Total*
B.C. General
Hospitals
B.C. Private
Hospitals
Institutions
outside B.C.
Adults and
Children
Newborn
Adults and
Children
Newborn
Adults and
Children
Newborn
Adults and
Children
Newborn
Patients discharged—
1949	
1950-  	
149,280
154,643
159,739
164,379
180,149
199,974
211,194
1,498,121
1,564,222
1,551,954
1,663.149
1,814,344
2,046,087
2,110,918
10.03
10.11
9.71
10.12
10.07
10.23
10.00
24,989
24,336
24,587
25,492
28,381
29,761
30,679
203,197
196,333
190,948
187,923
200,738
215,507
215,122
8.13
8.07
7.76
7.37
7.07
7.24
7.01
140,168
144,959
150,116
154,336
169,167
189,713
200,510
1,430,646
1,476,615
1,467,102
1,569,974
1,712,878
1,954,823
2,012,303
10.21
10.19
9.77
10.17
10.13
10.30
10.04
24,640
23,943
24,172
25,023
27,830
29,483
30,283
200,585
193,307
187,891
184,160
197,100
213,587
212,510
8.14
8.07
7.77
7.36
7.08
7.24
7.02
7,093
7,617
7,308
7,431
8,173
7,602
8,745
45,960
65,326
62,771
68,892
75,518
66,960
78,792
6.48
8.58
8.59
9.27
9.24
8.81
9.01
151
173
171
161
229
199
233
1,146
1,288
1,155
974
1,353
1,251
1,449
7.59
7.44
6.75
6.05
5.91
6.29
6.25
2,019
2,067
2,315
2,612
2,809
2,659
1,939
21,515
22,281
22,081
24,283
25,948
24,304
19,823
10.66
10.78
9.54
9.29
9.24
9.14
10.22
198
220
1951	
244
1952   	
1953                       	
308
322
19542   	
19553 	
Patient-days—
1949  —
1950.  	
1951   . _	
79
163
1,466
1,738
1,902
2,789
1952 	
1953                   .      _
2,285
669
19542 	
19553	
1,163
Average days of stay—
1949 — 	
1950 	
1951 _  	
1952	
7.40
7.90
7.79
9.06
1953  	
1954=  	
19553— _	
7.10
8.47
7.13
1 New-born totalled separately.
2 Amended as per final reports received from hospitals.
3 Estimated, based on hospital reports to November 30th, 1955.
Estimated days per thousand of population covered by British Columbia Hospital Insurance Service:   1949, 1,528;
1950, 1,548;   1951, 1,496;   1952, 1,545;   1953, 1,638;   1954, 1,786;   1955, 1,782.
Table Hb.—Summary of the Number of B.C.H.I.S. In-patients
and Short-stay Patients, 1949-55
Total Adults,
Children, and Newborn In-patients
Estimated Number
of Short-stay
Patients
Total Receiving
Benefits
1949                                                      - 	
174,269
178,979
184,326
189,871
208,530
229,735
241,873
29,000
44,502
47,656
46,767
52,582
63,621
76,163
203,269
1950                                                        	
223,481
1951        	
1952                                 	
231,982
236,638
1953                                                                -	
261,112
1954*      	
19552                                            	
293,356
318,036
Totals	
1,407,583
360,291
1,767,874
1 Amended as per final reports from hospitals.
2 Estimated, based on hospital reports to November 30th, 1955. HOSPITAL INSURANCE SERVICE REPORT,  1955
Z 21
Table III.—Patients Discharged, Total Days' Stay, and Average Length of Stay
in British Columbia General Hospitals for B.C.H.I.S. Patients Only,
Grouped according to Bed Capacity, Year 1955.-
Bed Capacity
Total
250 and
Over
100 to 249
50 to 99
25 to 49
Under 25
Special
Patients discharged—
200,510
30,283
2,012,303
212,510
10.04
7.02
75,514
9,910
937,266
74,072
12.41
7.47
39,096
6,121
372,677
44,346
9.53
7.24
45,045
8,981
379,821
60,061
8.43
6 69
26,647
3,581
206,771
23,174
7.76
6 47
9,944
1,375
73,225
8,879
7.36
6.46
4,264
315
Patient-days—
42,543
1,978
Average days of stay—
9.98
6.28
1 Estimated, based on hospital reports to November 30th, 1955.
Table IV.—Percentage Distribution of Patients Discharged and Patient-days
for B.C.H.I.S. Patients Only, in British Columbia General Hospitals,
Grouped according to Bed Capacity, Year 1955.1
Bed Capacity
Total
250 and
Over
100 to 249
50 to 99
25 to 49
Under 25
Special
Patients discharged—
Per Cent      Per Cent   I   Per Cent
100.00            37.65             19.50
100.00             32.72             20.21
1                    1
100.00            46.58             18.52
100.00       I       34.86              20.87
Per Cent
22.47
29.66
Per Cent
13.29
11.83
Per Cent
4.96
4.54
Per Cent
2.13
1.04
Patient-days—
1                        1
18.87             10.28               3.64
28.26               10.90                 4.18
2.11
0.93
1 Estimated, based on hospital reports to November 30th, 1955. Z 22
BRITISH COLUMBIA
Graph Showing Appendicitis, Neoplasms, and Tonsils and Adenoids, Which Were
among the Leading Causes of Hospitalization in British Columbia in 1954,
by Age of Patients and Length of Stay.
AVG. DAYS' STAY
16
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YEARS HOSPITAL INSURANCE SERVICE REPORT,  1955
Z 23
Graph Showing Arteriosclerotic Heart Disease, Pneumonia, and Deliveries,
Which Were among the Leading Causes of Hospitalization in British
Columbia in 1954, by Age of Patients and Length of Stay.
AVG. DAYS' STAY
24 i r
22
20
MALE -
FEMALE ■
0-9 10-19 20-29        30-39
40-49       50-59
YEARS
60-64        65-69       70-74 75+  HOSPITAL INSURANCE SERVICE REPORT,  1955
Z 25
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BRITISH COLUMBIA
DAYS
INFECTIVE AND
PARASITIC
H NERVOUS SYSTEM
NEOPLASMS
CIRCULATORY
2 SYSTEM
CONGENITAL
MALFORMATIONS
H] MENTAL, ETC.
SUPPLEMENTARY
^ CLASSIFICATIONS
AVERAGE
LENGTH  OF STAY
OF  PERSONS  HOSPITALIZED
IN  BRITISH  COLUMBIA
BY MAJOR  DIAGNOSTIC
CATEGORIES
1954
fH LIVE BIRTHS
DELIVERIES,
^ PREGNANCY, ETC.
SYMPTOMS
^ SENILITY, ETC.
RESPIRATORY
J KEY
HOSPITAL INSURANCE SERVICE REPORT,  1955
Z 27
7
2
11.4
6
8.1
14
"*X*X*X*X*X*X*_vX'X*X*X**v*
4.4
15
miWMm-M
3.4
16
2.5
2.4
KEY TO MAJOR DIAGNOSTIC CATEGORIES
3
1
18
■7 ¥:zm
9
1.9
1.6
1.5
1.4
1.3
1. INFECTIVE AND PARASITIC
2. NEOPLASMS
3. ALLERGIC, ETC.
4. BLOOD
5. MENTAL
6. NERVOUS SYSTEM
7. CIRCULATORY SYSTEM
8. RESPIRATORY SYSTEM
9. DIGESTIVE SYSTEM
10. GENITO-URINARY SYSTEM
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. SUPPLEMENTARY CLASSIFICATIONS.
8  :$%%:  1.2
i o .£»•»■:■ i .o
5 1.3
12 | .2
13 |.2
ll|.0
19 B —
CASE FATALITY RATES
— PER   100  PATIENTS —
HOSPITALIZED  IN   BRITISH COLUMBIA
BY MAJOR  DIAGNOSTIC CATEGORIES
1954 Z 28 BRITISH COLUMBIA
STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR THE FISCAL
YEAR ENDED MARCH 3 1st, 1955
Administration—
Salaries           $288,677.16
Temporary assistance  13,534.58
$301,211.74
Office expense   32,440.85
Travelling expense   19,958.67
Office furniture and equipment  33.70
Tabulating   9,183.27
Advertising and publicity   .._  456.50
Hospital surveys   $1,306.55
Less recovered     3,129.76
(Credit) 1823.21
Contingencies (cost of plan conversion)—
Salaries         $ 128,030.42
All other expenditure   94,528.73
Payments to hospitals—
Claims  $28,717,316.13
Vancouver   General   Hospital   re   out-patients
(" Hospital Insurance Act," sec. 35 (30)) .... 149,831.10
$28,867,147.23
Less collections, third-party liability  86,353.39
$28,780,793.84
Grants in aid of construction and equipment of hospitals _ 1,692,282.82
$30,473,076.66
Less payable from Hospital Construction Fund ...   $1,451,402.21
Less recovery from Federal Government of Federal share of construction costs advanced by
Province in previous years         367,404.15
       1,818,806.36
$362,461.52
222,559.15
28,654,270.30
$29,239,290.97
Less  Provincial  per  diem   grants   ("Hospital   Insurance  Act,"
sec. 40 (I))      $1,701,710.30
Less municipal per diem grants ("Hospital Insurance Act," sec.
40 (2))        1,003,166.60
Less sale of office furniture and equipment  14,125.25
Less sale of motor-vehicle   310.00
      2,719,312.15
Total,   Hospital  Insurance  Service,  charged  to  Vote  319,   Consolidated
Revenue Fund   $26,519,978.82 HOSPITAL INSURANCE SERVICE REPORT,  1955 Z 29
Hospital Insurance Fund
Credit balance at March 31st, 1954   $6,489,471.92
Add sale of office furniture and equipment  21,479.25
$6,510,951.17
Less refunds of premiums      3,887,136.23
$2,623,814.94
Less balance transferred to Refunds of Expenditure out of Income    2,623,814.94
Balance at March 31st, 1955   Nil
Hospital Construction Fund
Balance at March 31st, 1954  Nil
Add amusements tax paid into Fund pursuant to sec. 16 of "Amusements Tax Act" (see Vote 133)   $1,451,402.21
Less payment of grants in aid of construction and equipment of
hospitals, chargeable to Fund under sec. 7 of " Hospital Construction Act ":  Transfer—Vote 319, Hospital Insurance Service    1,451,402.21
Balance at March 31st, 1955   Nil
Certified correct and in accordance with the Public Accounts for the fiscal year ended March
31st, 1955.
C. J. Ferber, C.A.,
Comptroller-General. Z 30
BRITISH COLUMBIA
APPROVED HOSPITALS IN BRITISH COLUMBIA
The following hospitals are designated under the Act as hospitals required to furnish
the general hospital services provided under the Act, or such of them as are available
in the hospital:—
Armstrong and Spallumcheen Hospital, Armstrong.
Arrow Lakes Hospital, Nakusp.
Bella Coola General Hospital, Bella Coola.
Bulkley Valley District Hospital, Smithers.
Burnaby General Hospital, Burnaby.
Burns Lake Hospital, Burns Lake.
Chemainus General Hospital, Chemainus.
Children's Hospital, Vancouver.
Chilliwack General Hospital, Chilliwack.
Creston Valley Hospital, Creston.
Cumberland General Hospital, Cumberland.
Enderby and District Memorial Hospital, En-
derby.
Fernie Memorial Hospital, Fernie.
Golden General Hospital, Golden.
Grace Hospital, Vancouver.
Grand Forks Hospital, Grand Forks.
Kelowna General Hospital, Kelowna.
Kimberley and District General Hospital (Mc-
Dougall Memorial), Kimberley.
King's Daughters' Hospital, Duncan.
Kootenay Lake General Hospital, Nelson.
Lady Elizabeth Bruce Memorial Hospital, Inver-
mere.
Lady Minto Hospital, Ashcroft.
Lady Minto Gulf Islands Hospital, Ganges.
Ladysmith General Hospital, Ladysmith.
Langley Memorial Hospital, Murrayville.
Lillooet District Hospital, Lillooet.
Lourdes Hospital, Campbell River.
McBride and District Hospital, McBride.
Mater Misericordiae Hospital, Rossland.
Matsqui, Sumas, and Abbotsford General Hospital, Abbotsford.
Michel Hospital, Michel.
Mission Memorial Hospital, Mission City.
Mount St. loseph's Hospital, Vancouver.
Nanaimo Hospital, Nanaimo.
Nicola Valley General Hospital, Merritt.
Nootka Mission General Hospital, Ceepeecee.
North Vancouver General Hospital, North Vancouver.
Ocean Falls General Hospital, Ocean Falls.
Penticton Hospital, Penticton.
Pouce Coupe Community Hospital, Pouce
Coupe.
Powell River General Hospital, Powell River.
Prince George and District Hospital, Prince
George.
Prince Rupert General Hospital, Prince Rupert.
Princeton General Hospital, Princeton.
Providence Hospital, Fort St. John.
Queen Alexandra Solarium for Crippled Children, Cobble Hill.
Queen Victoria Hospital, Revelstoke.
Quesnel General Hospital, Quesnel.
Red Cross Outpost Nursing Station, Alexis
Creek.
Red Cross Outpost Nursing Station, Atlin.
Red Cross Outpost Nursing Station, Bamfield.
Red Cross Outpost Nursing Station, Blue River.
Red Cross Outpost Nursing Station, Edgewood.
Red Cross Outpost Nursing Station, Hudson
Hope.
Red Cross Outpost Nursing Station, Kyuquot.
Red Cross Outpost Nursing Station, Lone Butte.
Rest Haven Hospital and Sanitarium, Sidney.
Royal Columbian Hospital, New Westminster.
Royal Inland Hospital, Kamloops.
Royal lubilee Hospital, Victoria.
R. W. Large Memorial Hospital, Bella Bella.
St. Bartholomew's Hospital, Lytton.
St. Eugene Hospital, Cranbrook.
St. George's Hospital, Alert Bay.
St. John Hospital, Vanderhoof.
St. Joseph's General Hospital, Comox.
St. Joseph's General Hospital, Dawson Creek.
St. Joseph's Hospital, Victoria.
St. Martin's Hospital, Oliver.
St. Mary's Hospital, Garden Bay.
St. Mary's Hospital, New Westminster.
St. Paul's Hospital, Vancouver.
St. Vincent's Hospital, Vancouver.
Salmon Arm General Hospital, Salmon Arm.
Skidegate Inlet General Hospital, Queen Charlotte City.
Slocan Community Hospital, New Denver.
Squamish General Hospital, Squamish.
Summerland General Hospital, Summerland.
Terrace and District Hospital, Terrace.
Tofino General Hospital, Tofino.
Trail-Tadanac Hospital, Trail.
University Health Service Hospital, University
of British Columbia, Vancouver.
Vancouver General Hospital, Vancouver.
Vernon Jubilee Hospital, Vernon.
Victorian Hospital, Kaslo.
War Memorial Hospital, Williams Lake.
West Coast General Hospital, Port Alberni.
White Rock Hospital, White Rock.
Wrinch Memorial Hospital, Hazelton.
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1956
500-156-8769  

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