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Tenth Annual Report British Columbia Hospital Insurance Service JANUARY 1ST TO DECEMBER 31ST 1958 British Columbia. Legislative Assembly 1959

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 PROVINCE OF BRITISH COLUMBIA
"HOSPITAL INSURANCE ACT"
Tenth Annual Report
British Columbia Hospital
Insurance Service
JANUARY 1st TO DECEMBER 3 1st
1958
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1959  Victoria, B.C., January 22nd, 1959.
To His Honour Frank Mackenzie Ross, C.M.G., M.C., LL.D.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
The undersigned has the honour to present the Tenth Annual Report of the British
Columbia Hospital Insurance Service covering the calendar year 1958.
E. C. MARTIN,
Minister of Health and Welfare. British Columbia Hospital Insurance Service,
Victoria, B.C., January 22nd, 1959.
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 1958.
D. M. COX, F.A.C.H.A.,
Commissioner, British Columbia Hospital
Insurance Service. DEPARTMENT OF HEALTH AND WELFARE
(British Columbia Hospital Insurance Service)
The Honourable Eric Martin, Minister of Health and Welfare.
Senior Administrative Staff
D. M. Cox, F.A.C.H.A., F.C.I., F.C.I.S., Commissioner.
L. F. Detwiller, M.A., M.H.A., Assistant Commissioner.
W. J. Lyle, F.C.I.S., Manager, Hospital Finance Division.
A. W. E. Pitkethley, Esq., Manager, Hospital Construction Division.
J. W. Mainguy, M.H.A., Manager, Hospital Consultation and Inspection Division.
W. A. Fraser, O.B.E., E.D., M.D.C.M., F.A.C.S., Medical Consultant.
K. G. Wiper, Esq., Administrative Assistant.
Mrs. G. Whelen, B.Com., Director, Research Division.  CONTENTS
Page
Ten Years in Review  9
The Federal-Provincial Hospital Insurance Plan  10
The "Hospital Insurance Act"  12
The "Hospital Act"  12
Methods of Payment to Hospitals  12
Application for Hospital Insurance Benefits  13
Persons Entitled to or Excluded from the Benefits under the " Hospital Insurance Act "13
Entitled to Benefits  13
Excluded from Benefits  14
Hospital Benefits Available in British Columbia  14
In-patient Benefits  14
Emergency Services and Minor Surgery  14
Hospital Benefits Available outside British Columbia   15
Organization and Administration of B.C.H.I.S  15
Organization Chart  16
Hospital Finance Division  15
Hospital Accounting  15
Hospital Claims  17
Hospital Construction Division  18
Hospital Projects Completed, 1958   19
Hospital Projects under Construction at Year-end  20
Projects in Advanced Stages of Planning and for Which Working Drawings
Are in the Process of Preparation  20
Additional Projects Developed through Various Planning Stages in 1958— 21
Hospital Consultation and Inspection Division  21
Victoria Office  21
Vancouver Office  22
Medical Consultation Division  23
Administrative Assistant  23
Eligibility Section  24
Third Party Liability Section  24
Research Division  24
General Office  26
Public Relations  26
Hospitals as Defined under the " Hospital Insurance Act"  27
Public Hospitals  27
Outpost Hospitals  28
Federal Hospitals  28
Private Hospitals (Providing General Hospital Services)  28
7 Y 8 BRITISH COLUMBIA
General Hospital Care  28
Table 1.—Patients Discharged and Days of Care and Proportion Covered by
British Columbia Hospital Insurance Service, 1949-58  29
Table Ha.—Patients Discharged, Total Days' Stay, Average Length of Stay
according to Type and Location of Hospital, and Days of Care per Thousand of Covered Population, 1949-58  30
Table IIb.—Summary of the Number of B.C.H.I.S. In-patients and Short-stay
Patients, 1949-58  31
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 1958  31
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 1958  31
Graphs—
Major Diagnostic Categories of Illness, Excluding New-borns, in Acute-care
Hospitals in British Columbia, 1957  32
A Cumulative Percentage Distribution of the Total Number of Patients Discharged from Hospital by Age-group with a Cumulative Percentage
Distribution Comparison by Sex Shown as Components of the Total, 1957 34
A Cumulative Percentage Distribution of Total Patient-days of All Patients
Discharged from Hospital by Age-group with a Cumulative Percentage
Distribution Comparison by Sex Shown as Components of the Total, 1957 35
Average Length of Stay of Patients in Acute-care Hospitals in British Columbia
by Major Diagnostic Categories (Excluding New-borns), 1957  36
Statement of Receipts and Disbursements for the Fiscal Year Ended March 31st, 1958 37 Tenth Annual Report of the British Columbia
Hospital Insurance Service
TEN YEARS IN REVIEW
On December 31st, 1958, the British Columbia Hospital Insurance Service completed its tenth year of providing all-inclusive hospital insurance coverage to the residents
of the Province. In the entire field of hospital operation, this decade has been the most
outstanding in the Province's history. If measured only in terms of dollars and cents, the
financial assistance provided through the Service toward the needs of the residents of
the Province and its hospitals is impressive. During these past ten years approximately
$248,000,000 has been paid toward over 2,160,000 hospital accounts, and an additional
$21,000,000 has been expended by the Provincial Government to assist hospitals with
construction costs and the purchase of equipment. Payments to British Columbia hospitals are now being made at the rate of almost $100,000 daily.
The objective of this Provincial programme of comprehensive hospital insurance
has been to ensure good and efficient hospital service for the people of British Columbia.
Since the establishment of the Service, its four most important functions have
been:—
To safeguard the residents of the Province from the financial burden associated
with hospitalization.
To enable hospitals to substantially improve their service to the public by
assuring them of a steady income and relieving them of a progressively
increasing number of uncollectable accounts.
To assist communities in providing fully adequate facilities by paying 50 per
cent of approved hospital-construction costs.
To help hospitals in establishing and maintaining high standards of patient-care
by providing professional consultative services.
An estimated 94 per cent of all patients in the Province's eighty-four acute-care
public hospitals are covered by the Hospital Insurance Service.    The remainder are
primarily non-residents, Workmen's Compensation recipients, and other self-responsible
persons.   The average hospital bill paid by the Hospital Insurance Service in 1958 was
$135, and the average length of hospital stay was ten days.   However, qualified residents
are covered for as long as they require hospital services for an acute condition, and many
individual bills of from $5,000 to $10,000 have been paid, the largest being an account
of $39,266 for a patient who was hospitalized in August, 1951, and who is still in
need of acute hospital care.
From January 1st, 1949, to March 31st, 1954, eligibility for benefits was dependent
upon individual premium payments, made under certain specified conditions. However,
it became progressively apparent that a contributory-premium plan could not achieve
universal coverage. British Columbia's transient labour groups comprise approximately
20 per cent of the total employment force. The collection of premiums from these groups
proved to be extremely difficult. In 1953, 8 per cent of the residents of the Province had
not complied with the " Hospital Insurance Act," which required that they register and
pay premiums for insurance coverage. Effective April 1st, 1954, the premium-payment
plan was terminated and the registration of residents was discontinued. Twelve months
consecutive residence within British Columbia became the determining factor for eligibility.    On July 1st, 1958, British Columbia entered the Federal-Provincial Hospital Y 10 BRITISH COLUMBIA
Insurance Plan (see below) and the qualifying period of one year was reduced to three
consecutive months' permanent residence.
Generally speaking, benefits include standard ward accommodation, dietary and
general nursing services, approved drugs and prescriptions, and all other available hospital
services. Out-patient benefits are also provided within twenty-four hours of being accidentally injured.
The consultative services of the highly qualified personnel on the staff of the Hospital
Insurance Service are available to any hospital or affiliated organization, and are designed
to ensure that a high standard of hospital operation is maintained. Such services, which
are described more fully elsewhere in this Report, include assisting in establishing a
hospital improvement district; conducting surveys to help determine the bed capacity
needed to adequately serve an area; reviewing proposed plans for construction; and
administrative guidance in the actual operation of a hospital. The extent to which these
services have been utilized becomes more apparent when it is realized what has been
accomplished in the field of hospital construction during this decade of development.
A total of sixty-nine major hospital projects have been completed, comprising 2,934 acute
beds, 368 chronic beds, and 643 staff and nurses' beds. The total cost of this gigantic
undertaking amounted to over $34,000,000. During this period the population of British
Columbia increased by 38 per cent and the number of patient-beds increased by nearly
40 per cent. However, these figures for a ten-year period seem almost insignificant when
compared with the present construction programme. There are, at the present time,
thirty-seven major projects under construction or at various stages of planning (including
those approved in principle), involving over 2,800 beds, at a gross expenditure of almost
$47,000,000. The Provincial Government, through the British Columbia Hospital Insurance Service, pays one-half of all approved costs for both acute- and chronic-hospital
construction plus one-third the cost of all approved equipment. Before another year
draws to a close, many areas of the Province will see the result of this tremendous programme of expansion. This increase in hospital facilities is assurance to British Columbians that every effort is being made to maintain adequate acute-care bed requirements
to meet the needs of a rapidly growing population.
The high standards of patient-care achieved by B.C. public hospitals and the rapid
growth in facilities during the past ten years have almost tripled the cost of hospital
operation in this Province. The degree of increase is apparent when the total expenditures of $15,860,000 made by B.C. public hospitals in 1948 are compared to an estimated
$44,000,000 in 1958. A percentage breakdown indicates that at the present time over
70 per cent of the over-all expenditures are for salaries and wages; food accounts for
approximately 8 per cent; drugs, medical, and surgical expenses, 7 per cent; fuel, light,
and water, 3 per cent; and miscellaneous expenses account for the remainder. It is
interesting to note that, on a departmental basis, 58 cents of every dollar spent in the
operation of a hospital goes toward the professional care of patients, and the balance goes
toward maintenance and operation of the physical plant, general administration, and
general service departments.
After ten years under a Provincial Government programme of hospital insurance,
British Columbia's acute-care public hospitals have expanded and developed to a point
where a high standard of patient-care is available in the Province, an achievement of
which all levels of hospital administration may be justly proud.
THE FEDERAL-PROVINCIAL HOSPITAL INSURANCE PLAN
July 1st, 1958, marked the commencement of the Federal-Provincial Hospital Insurance Plan, which made it possible for the people of other Provinces to enjoy those benefits
which have been available to the residents of British Columbia for ten years. HOSPITAL INSURANCE SERVICE,  1958 Y 11
Under this programme, which was developed between the Federal and Provincial
Governments, each Province is charged with the development of its own hospital insurance plan and is responsible for its administration and operation. The part taken by the
Federal Government is that of sharing certain stipulated costs with the Provinces on a
calculated formula basis, provided the Provincial plan meets certain minimum requirements set forth in the Federal Act and regulations.
The formula for Federal payments is on the basis of 25 per cent of the Provincial
per capita cost plus 25 per cent of the Canadian per capita cost for hospital care. British
Columbia, being a Province with higher incomes and higher costs than are generally
found elsewhere in Canada, along with a high ratio of beds for the population, will receive
from the Federal Government slightly less than 50 per cent of hospital claims paid on
behalf of residents of the Province.
The Federal sharing arrangement is not a clear gain to' the Province. The Government of Canada insisted that a number of cost items formerly borne by the Federal
Government must now be paid by the Provincial Government's Hospital Insurance
Service. These may total as high as $3,000,000 annually in British Columbia. The
largest single item is the hospitalization of persons in receipt of War Veterans' Allowances.
This alone may cost close to $ 1,000,000. The majority of these payments will be made
to veterans' hospitals. In addition, the Federal Government has stated that it will not
share a substantial range of necessary costs, totalling at least $1,200,000, and the Federal
Government does not share in any portion of administrative costs of Provincial plans.
In anticipation of the commencement of the Federal-Provincial plan, the Provincial
Legislature abolished, effective April 1st, 1958, the charge to municipalities of 70 cents
per patient-day. Previously each municipality had been charged 70 cents for every day
that a municipal resident was a patient in hospital. The elimination of this charge will
result in a saving to municipalities of more than a million dollars a year.
A further benefit is the substantial reduction in the period of time a person is
required to live in British Columbia before becoming eligible for hospital insurance
benefits. The qualifying period of residence, effective July 1st, was shortened from the
former twelve months to three months. The increase in the number of hospital accounts
payable by British Columbia Hospital Insurance Service through this reduction will cost
approximately $750,000 annually.
Out-of-Province coverage, which has always been a part of the British Columbia
programme, providing protection anywhere in the world, was improved in two ways.
In place of the former out-of-Province benefits, limited to $8 per day, the British
Columbia Hospital Insurance Service now pays, in each Province with a hospital insurance plan, the standard ward rates set by the Service there, less $1 a day payable by the
patient. For hospitalization in other countries and in Provinces without insurance plans,
B.C.H.I.S. coverage was increased to a maximum of $12 per day for standard ward care.
The responsibility and procedure for the construction of new hospital facilities and
the provision of equipment remained unchanged. Hospital construction continues to be
the community's responsibility and must be initiated at that level. The Provincial
Government, through British Columbia Hospital Insurance Service, gives 50 per cent
grants for approved hospital construction, which is the most generous assistance toward
hospital construction given by any government in Canada.
The proposal of a Federal-Provincial hospital insurance plan many months ago
stimulated considerable interest throughout Canada in the study of government-sponsored
programmes of hospital insurance. Federal officials and authorities from other Provinces
fully realized the importance of conducting detailed studies of British Columbia's
comprehensive hospital insurance programme, which was in its tenth year of operation.
During 1958 several teams of government observers spent a number of weeks studying
the various aspects of B.C.H.I.S. operation and administration.   Representatives of the Y 12 BRITISH COLUMBIA
Federal Government visited the Hospital Insurance Service on several occasions to
discuss all aspects of the Provincial programme.
During 1958 senior officials of the British Columbia Hospital Insurance Service
attended three conferences at Ottawa for the purpose of conducting the negotiations
which resulted in British Columbia joining with the Government of Canada in inaugurating a Federal-Provincial hospital insurance plan.
THE "HOSPITAL INSURANCE ACT"
The "Hospital Insurance Act" is the Statute which establishes and controls the
operation of the Hospital Insurance Service. Its main provisions may be summarized
as follows:—
(1) Generally speaking, all persons who have permanently resided in British
Columbia for three consecutive months prior to going to hospital are
entitled to hospital benefits.
(2) Payment of hospital accounts for acute hospital care, including the acute
phase of any illness, and chronic conditions requiring in-patient care in
approved public hospitals.
(3) Benefits include standard ward accommodation, food and general nursing
services, the use of the operating-room, case-room, almost all drugs and
dressings, and in fact practically all services that are provided by the
hospital.
(4) The patient is required to pay $1 per day (except welfare recipients).
(5) In addition to in-patient care, the use of out-patient facilities required
within twenty-four hours of an accident or for minor surgery are provided
as benefits.   The patient pays a nominal charge of $2.)
(6) The residents of British Columbia are entitled to limited out-of-Province
hospital insurance benefits if hospitalized during their first three months'
absence.
THE "HOSPITAL ACT"
One of the important functions of the Hospital Insurance Service is the administration of the " Hospital Act." The Commissioner of the Hospital Insurance Service is
also the Chief Inspector of Hospitals for British Columbia under this Statute.
The "Hospital Act" controls the organization and operation of hospitals and
specifies three different types, as follows:—
(1) Public hospitals—operated by non-profit organizations for acute care.
(2) Private hospitals—generally privately owned and profit-making units.
(3) Chronic and convalescent hospitals — these are non-profit hospitals
approved under Part III of the " Hospital Act" and are operated primarily
for the treatment and rehabilitation of chronic patients.
METHODS OF PAYMENT TO HOSPITALS
A system of firm budgets for hospitals, which has been in use since January 1st,
1951, provides for a review of hospitals' estimates by the Rate Board of the Hospital
Insurance Service. Under the firm-budget procedure, hospitals are required to operate
within their approved budgets, with the exception of fluctuation in days' treatment and
other similar items. They are further advised that deficits incurred through expenditures
in excess of the approved budget will not be met by the Provincial Government. The
value of variable supplies used in patient-care has been determined. It is generally
recognized that the addition of a few more patient-days does not add proportionately
to patient-day costs because certain overhead expenses (such as heating, etc.) are not
affected.    However, some additional supplies will be consumed, and it is the cost of HOSPITAL INSURANCE SERVICE,  1958 Y 13
these variable supplies which has been determined. When the number of days' treatment
provided by the hospital differs from the estimated occupancy, the budgets are increased
or decreased by the number of days' difference multiplied by the patient-day value of
the variable supplies. Individual studies and additional budget adjustments are made
in those instances where large fluctuations in occupancy involve additions or reductions
in stand-by costs.
The majority of hospital accounts are the responsibility of the British Columbia
Hospital Insurance Service. Every month the Service pays each hospital 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, which are all-inclusive—that is, the
daily rate covers the cost of all the regular hospital services, such as X-ray, laboratory,
operating-room, etc., provided to patients, in addition to bed, board, and nursing care.
In 1958 approximately 94 per cent of all patients were covered by the Service.
The remainder included recipients of Workmen's Compensation and other agencies,
non-residents, etc. This compares with an average of approximately 85 per cent coverage experienced prior to terminating the premium-payment programme on March 31st,
1954.
APPLICATION FOR HOSPITAL INSURANCE BENEFITS
When admitted to an acute-care hospital, a patient wishing to apply for coverage
under the hospital insurance programme is required to make an application for benefits.
The hospital is responsible for verifying the patient's statements regarding length of
residence, etc., to determine if the patient is a qualified resident as defined under the Act
and regulations. Payment of the account is then requested from the Hospital Insurance
Service, which may reject any account where statements regarding residence do not meet
requirements (see Eligibility Section, p. 24).
PERSONS ENTITLED TO OR EXCLUDED FROM THE BENEFITS
UNDER THE "HOSPITAL INSURANCE ACT"
Entitled to Benefits
A person is considered entitled to benefits if he qualifies as a beneficiary under the
"Hospital Insurance Act." Generally speaking, a person is a beneficiary 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 has made his home in
the Province and has lived continuously therein during the preceding three
consecutive months;  or
(b) Having 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.
During the three-month residence qualification period, a person is permitted to be
temporarily absent from British Columbia for a total of one month without suffering any
postponement of the date on which he becomes a beneficiary.
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. Y 14 BRITISH COLUMBIA
If a man's wife and dependent children arrive in British Columbia after he does,
they are entitled to assume his residential status as of the date of their arrival.
The foregoing general description may be varied somewhat by the special arrangements that are in effect regarding persons who move to British Columbia from another
Province which has a Federal-Provincial hospital insurance plan in effect.
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; or
(b) A resident who leaves British Columbia and fails to return and re-establish
residence within twelve months; or
(c) An inmate of a Federal penitentiary;  or
(d) A patient in a Provincial tuberculosis sanatorium; or
(e) A resident who receives hospital treatment provided under the "Workmen's Compensation 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—for example, members of the armed
forces or Royal Canadian Mounted Police.
HOSPITAL BENEFITS AVAILABLE IN BRITISH COLUMBIA
In-patient Benefits
In addition to standard ward accommodation with meals and general nursing
services, a beneficiary may receive any of the other services available in the hospital,
which may include:—
Laboratory and X-ray services.
Drugs, biologicals, and related preparations (with certain exceptions).
Use of operating-room and case-room facilities.
Use of anaesthetic equipment, supplies, and routine surgical supplies.
Use of radiotherapy and physiotherapy facilities where available.
Active treatment of the acute stage of chronic disease (where it is proven to the
Commissioner that treatment in an acute general hospital is an urgent
medical necessity).
Other approved services rendered by employees of the hospital.
Note.—Private or semi-private rooms cost more to maintain than standard wards,
and a patient is required to pay extra for such accommodation.
Emergency Services and Minor Surgery
The following services are also provided in British Columbia hospitals to persons
who do not require in-patient care:—
Emergency treatment rendered within twenty-four hours of being accidentally
injured.
Operating-room or emergency-room services for minor surgery, including application and removal of casts.
The hospital charges beneficiaries $2 for each visit.    The remainder of the cost
is paid by the British Columbia Hospital Insurance Service.    However, if the patient
receives treatment from a private physician, he is responsible for paying for the doctor's
services, as such charges are not payable by the Hospital Insurance Service. HOSPITAL INSURANCE SERVICE,  1958 Y 15
HOSPITAL BENEFITS AVAILABLE OUTSIDE BRITISH COLUMBIA
Benefits are available anywhere in the world to a beneficiary under British Columbia's
plan if he is admitted to an approved general hospital for medically necessary in-patient
care for an acute illness or condition within the first three months after leaving British
Columbia. This applies both to beneficiaries who are temporarily absent from the Province and those who have moved elsewhere. The maximum period during which coverage
can be provided is three months, and this applies only to in-patient benefits; emergency
services and minor surgery rendered to out-patients are excluded.
If hospitalization takes place in another Province that has a Federal-Provincial
hospital insurance plan, the British Columbia Hospital Insurance Service will pay the
hospital at the standard ward rate approved by the Provincial authority concerned, less
$ 1 per day. If the daily rate includes a capital charge related to the cost of hospital buildings or equipment, it is payable by the patient because such items are not included in the
rates charged by British Columbia hospitals. Elsewhere, payment will be made at a rate
not exceeding $12 per day ($4 for new-born infants).
A written application for benefits must be received by the British Columbia Hospital
Insurance Service within six months of the date of admission to hospital. If any accounts
have been paid in full or in part by the patient, the application should include receipts
together with itemized statements. It is essential that particulars of diagnosis and treatment be included. All of this information is required by the British Columbia Hospital
Insurance Service before the claim may be paid.
ORGANIZATION AND ADMINISTRATION OF B.C.H.I.S.
The Hospital Insurance Service operates as a branch of the Department of Health
and Welfare under the Minister of Health and Welfare. It is administered by a Commissioner, who has the status of a Deputy Minister. In this manner the policies of the
Hospital Insurance Service and the amount of funds allocated to hospital care are controlled by the elected representatives of the people.
The main administrative divisions of the Hospital Insurance Service and their functions follow.
Hospital Finance Division
W. J. Lyle, Manager
The Hospital Finance Division performs two main functions—hospital accounting
and payment of hospital claims. Other responsibilities include the control of hospital
requests for grants in connection with capital expenditures for equipment and recommending approval for payment. It also supervises the appropriation covering long-term
pediatric care.
The following is a brief outline of the methods by which the Division's main functions
are carried out:—
Hospital Accounting
G. L. Morris, C.A., Supervisor
The Hospital Accounting staff is concerned with hospital financial operations in
relation to the budgets approved by the Hospital Rate Board. This entails frequent
inspectional visits to hospitals to review financial and statistical records and procedures,
and visits, extending from three days to three weeks, were made at least once during the
year to eighty-three public hospitals. Accounting assistance and instruction is also given,
on request, to the smaller public hospitals in the Province.
Other functions performed by the Hospital Accounting staff include:—
(a) Tabulating monthly statistical and financial reports from hospitals and
collating with the approved budgets.
. Y 16
BRITISH COLUMBIA
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(b) Determining the semi-monthly cash advances to be made to hospitals.
(c) Checking and amending annual financial and statistical reports prepared
by hospitals for the Dominion Bureau of Statistics.
(d) Carrying out such accounting inspections and cost studies of nursing homes
and chronic institutions as may be requested by the Social Welfare Branch
for rate-fixing purposes.
(e) In collaboration with Federal Treasury officials and the Hospital Construction Division of the Service, auditing the accounts of hospital-construction
projects for the purpose of determining the respective construction grants
payable to hospitals.
Experience during the first few years' operation of the Hospital Insurance Service
indicated that operating costs required serious consideration when planning new hospitals
and additions to existing hospitals. In order to ensure that plans for new hospitals or
hospital additions are prepared with economical and efficient operation in mind, a system
of pre-construction operating budgets is used. The procedure requires a hospital to
prepare an estimate of staff and other costs, based upon a reasonable occupancy for the
new areas. These estimates are submitted to the Hospital Insurance Service and are
reviewed by the Hospital Rate Board in the same manner as normal operating estimates.
It is essential that the estimated operating costs of the new hospital, or new wing, compare favourably with other hospitals actually in operation. Where the hospital's pre-
construction operating estimates do not indicate a reasonable operating cost, it is
necessary for them to revise their construction plans to ensure efficient and economical
operation. Once a satisfactory pre-construction operating estimate has been agreed upon
by the hospital officials and the Hospital Insurance Service, the hospital boards are
required to provide written guarantees relative to the projected operating cost. It is
considered that this method of approaching the operating picture for proposed hospital
facilities ensures more satisfactory planning, efficient use of hospital personnel, and an
economical operation.
The participation of the Federal Government in the British Columbia hospital
insurance programme resulted in the Hospital Accounting Section becoming responsible
for the preparation of much additional financial and statistical information required under
the provisions of the Federal " Hospital Insurance and Diagnostic Services Act." The
new plan has also involved changes in the accounting system of B.C. hospitals for the
purpose of providing more detailed departmental financial accounts and an extension of
the statistical requirements from public hospitals. Close liaison with Federal Health and
Treasury Department officials is being maintained and procedures developed for further
co-operation.
The 1957 Annual Report on Hospital Statistics was prepared by this office.
Hospital Claims
W. J. Wade, Supervisor
The Hospital Claims staff is responsible for screening and, where applicable,
approving for payment all admission-discharge records which hospitals submit in respect
of every patient. Every claim is checked by this office, whether it is charged to this
Service, to the patient, or to some other responsible agency. Approximately 1,225 claims
were processed each working-day.
This office comprises a number of sections, each having responsibility for a particular
phase of screening and processing claims.
The Admission Control Section reviews each Application for Benefits made by
patients who claim to be qualified for benefits under the "Hospital Insurance Act."
Details of residence and employment provided by the patient are checked with the
verifying documents attached to the claim by the hospital.   This Section works closely Y 18 BRITISH COLUMBIA
with the Eligibility Division inspectors. Advice and assistance are given to hospital
admitting staffs regarding proper completion of admission-discharge records and methods
of obtaining proof of the patient's residence.
The Accounts Payment Section verifies the total charges made to this Service and
ensures that all information shown on the claim is completed for statistical purposes.
This Section screens each claim to determine that the account has been charged to the
correct agency—that is, British Columbia Hospital Insurance Service, Workmen's Compensation Board, Department of Veterans' Affairs, etc. A monthly reconciliation of
accounts is carried out with each hospital. In addition, this office screens all claims
which may involve third-party liability and, where necessary, obtains further data.
During the year a total of 273,054 accounts were paid, compared with 257,498 in 1957
and 253,001 in 1956.
The Social Welfare Records Section maintains a complete alphabetical file of all
medical identity cards issued to welfare recipients for this Province. Hospital accounts
incurred by welfare recipients are checked against this file to determine eligibility for hospital benefits, including the dollar-a-day charge. Information regarding medical identity
numbers is provided on request to welfare authorities, doctors' offices, and certain other
agencies.
The Vouchering and Key-punch Sections are responsible for batching and voucher-
ing fully checked accounts, in order to determine the total amounts payable to each hospital and to prepare I.B.M. punch-cards recording statistical, financial, and medical data.
Approximately 1,600 punch-cards are processed daily and form the basis from which this
office prepares tabulated listings of accounts paid to hospitals and, for the first three
months of the year, listings of per diem charges to municipalities.
The Out-of-Province Section administers the screening and payment of accounts incurred in hospitals outside British Columbia. This Section is responsible for obtaining
an Application for Benefits and for checking to ensure that the patient is entitled to receive
out-of-Province benefits. During 1958 a total of 2,402 accounts, in the amount of
$210,374.08, were paid on behalf of qualified residents who were hospitalized in other
Provinces of Canada, the United States, Alaska, Hawaii, Mexico, British West Indies, the
United Kingdom, Eire, Australia, France, Switzerland, Italy, Holland, West Germany,
Norway, Denmark, Sweden, Hong Kong, and Japan.
The Filing Section sorts and files an average of 3,800 forms and letters daily.
Patients' records for the year 1957 were microfilmed by the Central Microfilm Bureau of
the Provincial Library, and 790,998 documents were processed, using 25,600 feet of film.
The Hospital Claims office continues to maintain close co-operation with the Medical
Consultant's Division, which provides technical advice to the various sections and also
screens medical data on all in-Province and out-of-Province claims.
(On September 18th, 1958, Mr. J. A. M. Moir resigned his position as Supervisor
of the Hospital Claims Section to enroll in the Anglican Theological College at the University of British Columbia. Mr. Moir had joined the staff of the Hospital Insurance Service
in August, 1948. The Assistant Hospital Claims Supervisor, Mr. W. J. Wade, was
appointed Supervisor.)
Hospital Construction Division
A. W. E. Pitkethley, Manager
This Division has three main responsibilities:—
(1) Assisting hospitals and their architects when planning new hospital facilities, or renovations and additions to existing buildings.
(2) Processing all applications for Provincial grant assistance toward the
cost of capital construction and improvements, other than movable equipment, and preparing applications for submission to the Federal Govern- HOSPITAL INSURANCE SERVICE,  1958 Y 19
ment for Federal grants toward the cost of construction projects that
qualify within their regulations.
(3)  The administrative supervision of the Marpole Provincial Infirmary, in
Greater Vancouver and the two branches in Victoria and Haney.    (The
manager of this Division serves as secretary of the Provincial Infirmary
Board of Management.)   These institutions have a total bed capacity of
298 beds, and during the year had occupancies ranging from 69.8 to 92.6
per cent.
A great deal of time is spent reviewing plans of proposed new facilities, forwarded
by hospitals throughout the Province.   Special attention is given to the design and layout
of a building to ensure that it can provide efficient and economical operation, a good
standard of patient-care, and adequate facilities for potential future expansion.   With the
co-operation of other divisions of the Service, hospital boards are provided with excellent
consultative services.   These services are augmented by various branches of the Health
Department, including Public Health Engineering, the Consultant in Nutrition, the Clinical Laboratory Services, as well as the Department of Paediatrics of the Faculty of Medicine of the University of British Columbia and the offices of the Steam-boiler Inspector
and Electrical Energy Inspector, which assist in examing heating and electrical plans.
The Federal Government, through the Chief of the Hospital Design Division, also assists
in an advisory capacity.
An attempt was made to devote more time in assisting hospitals in current and
long-range planning by visiting the hospitals and studying their problems.
The following resume of construction is evidence of the activity of this Division
throughout the calendar year 1958.
(a) Hospital Projects Completed during 1958
Castlegar and District Hospital, Castlegar.—The new Castlegar hospital of 33 beds
and 10 bassinets was officially opened on April 19th, 1958. The building is constructed
of reinforced concrete, having a main floor plus a partial basement.
Fraser Canyon Hospital, Hope.—The hospital of 26 beds and 8 bassinets, plus a
separate staff residence of 5 beds, was substantially completed before the end of 1958,
althought the official opening was not scheduled until January 10th, 1959. The hospital
has a reinforced-concrete basement and floor slab, the exterior walls are masonry, with
frame partitions elsewhere.   The residence is of frame construction.
The Lady Minto Gulf Islands Hospital, Ganges.—On April 16th, 1958, the new
Lady Minto Gulf Islands Hospital was officially opened. It has provision for 21 beds and
6 bassinets. The building has a reinforced-concrete basement and main floor slab; the
exterior walls are concrete block. Unfinished areas in the hopital will provide 4 additional beds when required.   The staff residence of 8 beds is a frame-constructed building.
St. John Hospital, Vanderhoof.—A staff residence of 14 beds was constructed. This
is a frame building, which was completed in the fall of 1958.
Chilliwack General Hospital, Chilliwack.—Patients were transferred to the new
addition of the Chilliwack hospital prior to the end of 1958. However, the alterations
programme to the existing hospital building will not be completed until early in 1959.
When the project is fully completed, the hospital will have provision for 146 beds and
27 bassinets.   A separate 30-bed staff residence was completed early in 1958.
Maple Ridge Hospital, Haney.—This hospital was officially opened on March 1st,
1958. It has 63 beds and 14 bassinets. The 2V^-story building of reinforced-concrete
construction uses the " double corridor " design in the nursing units. Expansion can be
achieved by means of a further floor.
Prince Rupert General Hospital, Prince Rupert.—The improvements and alterations
to the Prince Rupert hospital were completed during the early part of 1958.    These Y 20 BRITISH COLUMBIA
alterations will provide facilities for improved services and better utilization of space for
bed facilities.
The Vancouver Preventorium, Vancouver.—The 70-bed addition to the preventorium was officially opened by Her Royal Highness Princess Margaret on June 23rd, 1958.
The building was occupied on October 23rd, 1958. The preventorium plans to accept
children suffering from various types of chronic illnesses and subacute cases from all parts
of the Province.
Queen Alexandra Solarium for Crippled Children, Victoria.—The new 64-bed
hospital-home-school for children with chronic illnesses was officially opened by the
Lieutenant-Governor on October 25th, 1958. The new hospital is located at Gordon
Head, Vancouver Island, overlooking Finnerty Bay.
Kootenay Lake General Hospital, Nelson.—This hospital officially opened on
December 12th, 1958. It has 95 beds set up initially. The fourth floor of the four-story
reinforced concrete building will have provision for a further 51 beds, which can be readily
brought into service when required.
St. Mary's Hospital, New Westminster.—The new 150-bed hospital building was
opened for patients early in November, 1958. Certain portions of the project, such as
the construction of the chapel, and the demolition of the old hospital building were,
however, not completed by the year's end. The over-all project is expected to be fully
completed early in 1959.
St. Paul's Hospital, Vancouver.—The new residence, which provides accommodation
for twenty-three interns, was completed prior to the end of 1958. The building is of
reinforced concrete and is structurally designed for a future floor to accommodate a
further fourteen interns.
(b) Hospital Projects under Construction at Year-end
Salmon Arm General Hospital, Salmon Arm:  New 50-bed hospital.
Lillooet District Hospital, Lillooet: New 17-bed hospital and 10-bed staff residence.
Burnaby General Hospital, Burnaby: Addition and alterations to existing building
to provide a total of 122 additional beds.
Prince George and District Hospital, Prince George: New 125-bed hospital and 54-
bed staff residence.
North and West Vancouver Hospital, North Vancouver:  New 283-bed hospital.
Kootenay Lake General Hospital, Nelson:   12-bed staff residence.
Kitimat General Hospital, Kitimat:   New 113-bed hospital.
Grace Hospital, Vancouver: Alterations to existing building, plus addition containing 30 beds.
Chilliwack General Hospital, Chilliwack:   Alterations to existing hospital building.
Surrey Memorial Hospital, Surrey:  New 95-bed hospital.
Vancouver General Hospital, Vancouver:  Acute unit, 504 beds,
Tofino General Hospital, Tofino:  9-bed staff residence.
(c) Projects in Advanced Stages of Planning and for Which Working
Drawings Are in the Process of Preparation
Kimberley and District General Hospital, Kimberley:   60 beds.
Golden General Hospital, Golden:  22 beds.
Burns Lake Hospital, Burns Lake:   36 beds.
Powell River General Hospital, Powell River:  Diagnostic areas.
St. Joseph's General Hospital, Dawson Creek:  60 beds.
Terrace and District Hospital, Terrace:  40 beds.
Bella Coola General Hospital, Bella Coola: 15-bed residence. It is expected that
construction will commence on this project early in January, 1959. HOSPITAL INSURANCE SERVICE,  1958 Y 21
(d)  Additional Projects Developed through Various Planning Stages in 1958
Nanaimo General Hospital, Nanaimo:   158 beds.
Royal Jubilee Hospital, Victoria: 64 beds plus areas for diagnostic and treatment
facilities.
St. Joseph's Hospital, Victoria:  31 beds.
Providence Hospital, Fort St. John:  60 beds.
Royal Inland Hospital, Kamloops: Alterations and addition to bring capacity up to
230 beds.
Mission Memorial Hospital, Mission:  Replacement to existing hospital.
Royal Columbian Hospital, New Westminster: Nurses' residence and laundry
building.
War Memorial Hospital, Williams Lake:  70 beds.
St. Paul's Hospital, Vancouver:  Laboratory department.
Hospital Consultation and Inspection Division
J. W. Mainguy, M.H.A., Manager
Victoria Office
Hospital inspection and administrative assistance are the main functions of this office.
It also plays an active part in the financial arrangements between the Hospital Insurance
Service and public hospitals. Considerable time is spent on work connected with hospital
operating estimates, and, in addition to the usual estimates, reviews are done on the
operating estimates submitted by groups planning new hospital construction. These pre-
construction estimates are reviewed to ensure that the new buildings can be staffed
economically after they have been constructed. The work on all operating estimates is
carried out in conjunction with the Hospital Finance Division.
In 1958 administrative assistance on a variety of problems was given to hospitals
during visits by members of the staff and by correspondence. Members of the staff of this
office continued to assist the Vancouver office in inspection visits and consultation to
licensed private hospitals. Personnel from this office participated in, or carried out
themselves, thirty visits to private hospitals. Sixty-seven visits for inspection, or to provide consultation service, were made to sixty public hospitals, including three Red Cross
outposts. In nineteen instances the visits were made by a team of two consultants. Visits
involved at least one day spent in the hospital and in some cases up to three days, during
which the various departments were studied and key personnel interviewed. Generally,
meetings were held with the board of directors and with members of the medical staff.
The office continued its work in processing draft by-laws, in conjunction with the
Administrative Assistant. Complete by-law revisions for eleven hospitals were reviewed
and suggestions made for their improvement. Model by-laws were distributed to several
other hospitals. A number of smaller amendments to by-laws were also processed during
the year. Reference material was provided to hospitals whose medical staffs were active
in reviewing their by-laws, and assistance was given in drafts of medical staff by-laws sent
in for review.
Extensive information on personnel matters was distributed to hospitals.
A Food Service Institute, jointly sponsored by the British Columbia Hospital Insurance Service and the Provincial Health Branch, was held at Cranbrook, October 14th to
18th. Cranbrook was chosen because it had the type of facilities required for this
institute, and at the same time it was relatively accessible to a number of hospitals. (St.
Eugene Hospital kindly provided the facilities of the former school of nursing.) The
institute was intended, primarily, to help persons supervising food service in smaller institutions, in the south-east portion of the Province, which do not have dieticians. For this
reason, hospitals which had a dietician were not invited to send personnel to the institute. Y 22 BRITISH COLUMBIA
Federal grants were made available to help offset the costs of sending representatives.
The institute was attended by representatives from fifteen general hospitals, two private
hospitals, and two boarding homes. In all, twenty-three persons attended all or part of
the course.
The faculty was composed of representatives from the Health Branch, from this
Division of the Hospital Insurance Service, from Kelowna and Trail hospitals, from the
Federal Department of Fisheries, and from the East Kootenay Health Unit. Topics
included were: Food Storage, Menu Planning, Therapeutic Diets, Food Purchasing,
Sanitation, Cost Control, and Work Planning.
It is felt that this food institute was of considerable assistance to the smaller institutions, and it is expected that it will provide valuable information in planning further
meetings of this type. The Nutrition Consultant of the Health Branch visited three hospitals on request, to give assistance with dietary problems.
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.
As in previous years, the Technical Supervisor, Clinical Laboratory Services of the
Health Branch, worked closely with this office in connection with certain problems.
A refresher course for medical laboratory technologists in smaller hospitals was
instigated by the Laboratory Advisory Council and was held during the week commencing
August 18th. Federal grants were made available to help offset the cost to hospitals of
sending representatives. Sixteen technologists attended the course, which was held in the
Medical School Laboratory at the Vancouver General Hospital. This Division is represented on the Laboratory Advisory Council and assisted in passing information to
hospitals regarding the course.
As in the past, liaison was maintained with hospitals and the Health Branch on the
problems of aseptic technique and the handling of infectious cases.
The Division worked closely with the Provincial Fire Marshal during 1958 in
connection with fire safety in hospitals.
The survey of pharmacy practices in hospitals being conducted by the Faculty of
Pharmacy of the University of British Columbia was continued during the year.
Vancouver Office
The primary activity of this office is the administration of Part II of the " Hospital
Act," which deals with the licensing, inspection, and construction of private hospitals.
In 1957 a dietary survey was completed by a consulting dietician. The results of the
survey were distributed in 1958 in the form of a list of the deficiencies in food service
which had been found in the survey, and recommendations for the necessary corrections
of these deficiencies. In addition, standards for food service were compiled and sent out
to private hospitals to assist them in planning and serving nutritious and attractive meals.
The consulting dietician continued her work with private hospitals on a part-time basis
during the year and had revisited twenty-four of them before the year-end. These visits
were to maintain a check on standards of food service and to provide any help the private
hospitals might require to improve their food service. The consulting dietician assisted in
conducting the food-service institute mentioned earlier in the Report.
Exclusive of the dietary visits, this office carried out eighty-three inspectional visits
to private hospitals, and thirty visits were made by personnel from the Victoria office,
chiefly in connection with assessment of nursing service to patients. Thus, in all, 137
visits were made to the sixty-three private hospitals in the year.
It should be remembered that in addition to these visits, inspections are being made
in private hospitals by sanitation and fire officials.
Seventy-four inquiries were received and answered as to the requirements for
establishment of a licensed private hospital.   One new hospital of 40 beds was licensed HOSPITAL INSURANCE SERVICE,  1958 Y 23
and four hospitals completed additions which together added 23 beds. One small 8-bed
hospital was closed by the owner for reasons of ill health. Because of economic conditions at Britannia, the private hospital there was formally closed, although it actually
ceased to handle patients in 1957. At the year-end there were sixty-three licensed private
hospitals, as follows:— Beds
Fifty-six licensed for chronic and convalescent medical patients
(nursing homes)    1,813
Seven licensed for medical, surgical, and maternity (general
hospitals)      170
1,983
This compared with a total of 1,758 nursing-home beds and 177 private general-
hospital beds at the end of 1957, an increase of 48 beds.
In December, members of the staff of this office and the Victoria office visited Seattle
to study at first hand the licensing and inspection programme for nursing homes in the
State of Washington.
A second major activity of this office is in the field of hospital clearance. Hospital
clearance is a method of moving, from acute general hospitals to suitable facilities, welfare
patients who no longer require the specialized services of an acute general hospital but
still need some form of care and cannot be sent home. The actual placement work is
done by the Social Welfare Branch upon request by this office. During 1958 there were
ninety-five requests for assistance from general hospitals; eighty-four cases were placed.
Medical Consultation Division
W. A. Fraser, O.B.E., E.D., M.D.C.M., F.A.C.S., Medical Consultant
The Medical Consultation Division reviews all hospital admission and discharge
records and recommends, from the medical aspect, that portion of the patient's length of
stay which may be authorized for payment by the Commissioner in accordance with the
" Hospital Insurance Act " and regulations. This review is carried out as soon as possible
following admission of the patient to hospital.
To a large degree the Medical Consultant is responsible for the quality of morbidity
data which is used for administrative purposes and which is subsequently published by
the Hospital Insurance Service. Basically, the data are obtained by the Medical Consultant's office from the diagnosis appearing on each admission-discharge record. After review, the medical coding section of this office allocates a morbidity code based on the
Manual of the International Statistical Classification of Diseases, Injuries, and Causes of
Death. During 1958, the seventh revision of this manual, published by the World
Health Organization, was adopted by this office, and this change-over necessitated considerable examination of the problems attendant on the coding of more than a quarter of
a million individual diagnoses each year. The accuracy of the morbidity statistics used by
the Service is influenced by the reviews to which the Medical Consultant and staff submit
the claims documents.
During the year a shortage of trained medical coders and checkers (due to reasons
such as illness, etc.), together with an increasing volume of hospital admission documents, placed an unusually heavy load on those responsible for producing the quality of
review that is essential for the tabulation of reliable statistics.
Administrative Assistant
K. G. Wiper
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 Y 24 BRITISH COLUMBIA
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, advice and
assistance are given to hospitals in regard to problems connected with by-laws and their
application. Changes in hospital by-laws are reviewed 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.
This office collaborates with the Water Rights Branch of the Department of Lands
and Forests and the Chief Electoral Officer in assisting communities in unorganized territory to establish hospital improvement districts for the purpose of raising funds by money
by-laws for improving hospital facilities in the area. At the end of 1958 there were
twenty-two such districts in operation and a number of others in the process of formation. Descriptive material outlining the procedures for establishing such a district is
supplied to interested groups by the office of the Administrative Assistant, upon request.
During 1958 considerable time was spent in preparation for the Federal-Provincial
hospital insurance plan. Statutes and regulations were revised as required by Federal
legislation, and extensive discussions were held with Federal officials in connection with
the preparation of the Hospital Insurance Agreement entered into between British Columbia and the Federal Government. In addition, liaison was established with other
Provincial Governments, primarily for the purpose of working out reciprocal arrangements to provide continuous coverage for residents.
This official is responsible for over-all supervision of the Eligibility and Third Party
Liability Sections.
Eligibility Section
In order to ensure that only qualified British Columbia residents receive hospital
insurance benefits, the staff of the Eligibility Section review the Application for Benefits
made by patients at the time of admission to hospital. In addition to investigating doubtful applications, Eligibility Inspectors visit hospitals regularly to see that B.C.H.I.S.
eligibility procedures are being properly carried out. Inspectors are located at Victoria,
Vancouver, Prince George, Kelowna, Kamloops, and Nelson and perform their duties
under the direction of the Eligibility Supervisor in Victoria.
Third Party Liability Section
The hospitalization reports that are completed by hospitals for every patient admitted
with accidental injuries are processed by the Third Party Liability Section. This Section
also handles the arrangements under which the 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. The
Senior Eligibility Inspector in Vancouver is also responsible for maintaining a third-party
liability clearing-house for the convenience of solicitors and insurance adjusters in the
Greater Vancouver area. Up-to-date information regarding the hospitalization of accident victims is available through this branch office, and negotiations may be carried out
in person or by telephone, thus avoiding the necessity of corresponding with the head
office in Victoria.
Research Division
Mrs. G. E. Whelen, B.Com., Director
During 1958 the main functions of this Division continued as follows:—
(1) To survey geographic areas within the Province, in order to determine
the need and size of new hospital construction. HOSPITAL INSURANCE SERVICE,  1958 Y 25
(2) To tabulate, compile, and analyse morbidity statistics, noted in the
admission-discharge records forwarded to the Service from British Columbia acute-care hospitals in respect to all in-patients.
(3) To assist the administration of the Service and other agencies with compilations of data which are not directly available from other divisions in the
Service.
However, in addition to carrying out the above-mentioned functions, considerable
study was given during the year to the future programming of the Research Division. In
this regard, an examination was made of the possibility of forwarding monthly morbidity
data to individual public hospitals who would benefit, not only from the availability of
current material, but would also gain from morbidity comparisons with other institutions
within a given bed-size range. The object of such a programme would be primarily to
assist the hospitals in the evaluation of work volume and maintenance of standards of
patient-care. While no definite change in the research programme was adopted, various
changes in methods of checking coding procedures and recommendations for use of
allocated business-machine time were submitted as an initial or preparatory step toward
improvement of the production of useful morbidity data. For example, a checking procedure was instituted which, in time, should reduce the time-lag between the end of the
calendar year and the date at which patient data for that year is finally produced. Reviews
were also made of the value of data produced for previous annual periods, and some
reorganization of the production of the 1957 statistical material resulted.
jArrangements were made to produce a special series of data not previously compiled
but required in future to meet with the Federal-Provincial Agreement with respect to the
" Hospital Insurance and Diagnostic Services Act." Prior to the implementation of the
aforementioned agreement, this office undertook an examination of the effect of the use of
interim population estimates in the formula prescribed by Federal regulations for determining the amount of Federal payments to Provincial Governments, and also participated
in many of the discussions and reviews relative to the agreement between Canada and
British Columbia.
As in previous years, studies of hospital bed needs involving comprehensive study of
the demographic, economic, and morbidity characteristics of given areas formed the major
work load of the Research Division. Examination of the hospital-utilization rates in certain areas were also made in connection with the estimates of future patient loads for
hospital budget purposes. Areas examined included McBride, Bella Coola, Bella Bella,
Burns Lake, Anahim Lake, Nanaimo, Abbotsford, and metropolitan Vancouver, with
particular attention in the latter area to North Vancouver, the University Endowment
Lands, and the more rural communities of Langley and Surrey. Publication was made of
the findings of the study of the Kamloops-Revelstoke and North Okanagan region of
British Columbia, while field work and preliminary collation of the data relating to the
Central Border and South Okanagan region were completed.
A member of the staff worked in co-operation with the Provincial Bureau of Economics and Statistics in compiling an age-group distribution of British Columbia's population by school districts, based on 1956 Census enumeration area data. The resultant
population figures have been of immeasurable value in the production of general and
specific hospital-utilization rates and in forecasting future active-treatment hospital bed
requirements.
To ensure further accuracy of community utilization figures, a third revision of An
Alphabetical Listing of Place-names in British Columbia with a Geographical Code was
prepared and published early in the year. While designed only as a mechanical administrative tool, this listing has been requested by numerous unallied organizations for its
usefulness as an up-to-date gazetteer. Y 26 BRITISH COLUMBIA
Information was assembled in connection with the volume of pediatric and infant
nursery cases currently being admitted to British Columbia hospitals and the relation of
the volume of these cases to the population as a whole.
General Office
W. H. Parker
The General Office handles the recording and accounting of all receipts and expenditures incurred in the administration and operation of the Hospital Insurance Service.
Accounting responsibilities also include an internal audit and preparation of the annual
estimates. Other duties comprise the handling of personnel matters; the requisitioning
and maintenance of supplies, furniture, and equipment; the sorting and distribution of
mail; and the shipment of forms to hospitals.
This office also processes requisitions, vouchers, and credits with respect to the
Provincial Infirmaries (Marpole in Vancouver, Mount St. Mary in Victoria, and Allco
in Haney), and distributes the $5 Comfort Fund payment to the patients at Mount St.
Mary. During 1958, amendments were made in respect to the control of patients'
pension cheques, resulting in greater safety of their handling.
A further responsibility of the General Office was the administration of Hospital
Insurance Regulation 8, whereby armed forces personnel could voluntarily register their
dependents for hospital insurance benefits. The Federal requirement that benefits should
be available to all residents on an equal basis necessitated the discontinuance of this
arrangement on July 1st, 1958, when the Federal-Provincial hospital insurance programme commenced. As at December 31st, 1958, 1,716 applicants paid $22,890 in fees
in order to register 4,435 dependents for hospital insurance coverage. Hospital Claims
Section reports that 1,320 claims (including new-borns) were paid on behalf of registered
dependents at a total cost to the Hospital Insurance Service of $100,640.68. These
figures are cumulative from May 1st, 1956, for the entire period in which Regulation 8
of the " Hospital Insurance Act" was in force.
Final collection of municipal per diem grants, cancelled as at March 31st, 1958,
amounted to $213,688.50, which was credited to miscellaneous revenue.
Up to November the supervisor of this office acted as Building Warden and Civil
Defence Officer for the Service, and in this capacity assisted with hospital disaster planning for the Provincial Civil Defence Co-ordinator.
Public Relations
R. H. Thompson
It is the responsibility of this office to maintain liaison with the Province's approved
public hospitals and to pursue a programme of public education.
During 1958 the B.C.H.I.S. Bulletin, an advisory circular clarifying those policy and
procedural changes which affect hospital administration, was prepared on a regular basis,
and 1,300 copies of each edition were mailed to over 100 hospitals. The General Information Handbook, originally printed in February, 1957, was revised, and a new printing
of 50,000 will be ordered early in the new year. The June edition of the British Columbia
Government News was devoted to the Hospital Insurance Service, and articles were
written on all aspects of the Service, including the advent of British Columbia's entry into
the Federal-Provincial Hospital Insurance Plan. In addition, articles were also prepared
for publication in B.C. newspapers and the Canadian Hospital, the official journal of the
Canadian Hospital Association. Toward the end of the year the submission of monthly
articles to the Canadian Hospital was initiated. A new bulletin-board notice was prepared, emphasizing the use of employers' certificates for establishing eligibility upon
hospital admission, and 12,000 were printed for distribution to over 2,000 employers. HOSPITAL INSURANCE SERVICE,  1958
Y 27
To assist hospitals with their admitting procedures, 300 posters were prepared and distributed for use in hospital admitting offices and public reception areas. A comprehensive
summary of all major policy changes, with related statistics, for the period January 1st,
1948, to July 1st, 1958, was prepared as reference material for in-service use. Eleven
maps of British Columbia, each 4 by 3 feet with an attached index listing the hospital
administrators and board chairmen, were prepared for use by senior officials.
At the request of the executive of the British Columbia Hospitals' Association, a
display was prepared for use at the association's forty-first annual convention, held in
Vancouver October 28th to 31st. This display was later used by a hospital society at its
annual meeting held in November and is now in the public reception area of the General
Office. The B.C.H.I.S. display in the British Columbia Building at the Pacific National
Exhibition was considerably revised in keeping with a Centennial theme incorporated in
all Provincial Government exhibits, in observance of the Province's Centennial Year
celebrations throughout 1958. British Columbia hospitals were asked to submit historical
material for possible use in the display, and several hospitals sent in old by-laws, annual
reports, board meeting minutes, and photographs. The majority of these historical documents were reproduced by the office of the Provincial Archivist, making a substantial
contribution to the Hospitals Section of the Archives.
The advisability of adding to the B.C.H.I.S. film library was studied, and several
16-mm. films and 35-mm. filmstrips were previewed to determine their suitability for
use by British Columbia hospitals in their in-service training programme. The final
rewrite of the Public Relations Guide for Hospitals was completed, and 300 offset copies
were requisitioned from the Queen's Printer for distribution to hospitals.
Other duties of this office include replying to letters requesting information and
descriptive literature on the Service (approximately 500 letters of this nature were
received during the year) and supervising the duplicating, collating, stapling, and mailing
of the major hospital insurance addresses given by the Minister of Health and Welfare.
This office also compiled and edited the British Columbia Hospital Insurance Service
Tenth Annual Report.
HOSPITALS AS DEFINED UNDER THE "HOSPITAL INSURANCE ACT"
(Designated by Order in Council No. 1391 of 1958, Effective July 1st, 1958)
Part I
Hospitals defined as such under section 2 of the "Hospital Act":—
Fort Nelson General Hospital, Fort Nelson.
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 Minto Hospital, Ashcroft.
Lady Minto Gulf Islands Hospital, Ganges.
Ladysmith General Hospital, Ladysmith.
Langley Memorial Hospital, Murrayville.
Lillooet District Hospital, Lillooet.
McBride and District Hospital, McBride.
Maple Ridge Hospital, Haney.
Mater Misericordiae Hospital, Rossland.
Matsqui, Sumas, and Abbotsford General Hospital, Abbotsford.
Michel Hospital, Michel.
(a) Public Hospitals
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.
Campbell River and District General Hospital,
Campbell River.
Castlegar and District Hospital, Castlegar.
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, Enderby.
Esperanza General Hospital, Ceepeecee.
Fernie Memorial Hospital, Fernie. Y 28
BRITISH COLUMBIA
Mission Memorial Hospital, Mission City.
Mount St. Joseph's Hospital, Vancouver.
Nanaimo General Hospital, Nanaimo.
Nicola Valley General Hospital, Merritt.
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, Victoria.
Queen Charlotte Islands General Hospital,
Queen Charlotte City.
Queen Victoria Hospital, Revelstoke.
Quesnel General Hospital, Quesnel.
Rest Haven Hospital and Sanitarium, Sidney.
Royal Columbian Hospital, New Westminster.
Royal Inland Hospital, Kamloops.
Royal Jubilee 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.
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 District Hospital, White Rock.
Windermere District Hospital, Invermere.
Wrinch Memorial Hospital, Hazelton.
(b) Outpost Hospitals
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.
Red Cross Outpost Nursing Station, Masset.
Sacred Heart Nursing Home, Hanceville.
Stewart General Hospital, Stewart.
(c) Federal Hospitals
Veterans' Hospital, Victoria.
Shaughnessy Hospital, Vancouver.
Coqualeetza Indian Hospital, Sardis.
Miller Bay Indian Hospital, Prince Rupert.
Nanaimo Indian Hospital, Nanaimo.
R.C.A.F. Station Hospital, Holberg.
Part II
Private hospitals which are defined as such under section 8 of the " Hospital Act,"
and with which the Province has entered into an agreement requiring the hospital to furnish the general hospital services provided under the " Hospital Insurance Act":—
Bralorne Private Hospital, Bralorne.
Cassiar Asbestos Corporation Private Hospital,
Cassiar.
Chatham House Private Hospital, Vancouver.
Gold Quartz Hospital, Wells.
Hollywood Sanitarium, New Westminster.
Kitimat Hospital, Kitimat.
Medical-Dental Hospital Unit, Vancouver.
Port Alice Private Hospital, Port Alice.
GENERAL HOSPITAL CARE
The tables on the following pages present statistical data compiled by the Hospital
Finance Division. The data deal with the volume of hospital coverage provided to the
people of British Columbia through the Hospital Insurance Service. Eighty-four public
hospitals were approved to accept B.C.H.I.S. patients. In addition, care was given in
eleven outpost hospitals, six Federal hospitals, and eight private hospitals (see listing
above). Data for the year 1958 have been prepared for preliminary unrevised reports
submitted by hospitals, and consequently is subject to minor revision. HOSPITAL INSURANCE SERVICE,  1958
Y 29
The average length of stay of B.C.H.I.S. adult and children patients in British
Columbia public hospitals during 1958 was 9.91, the same as in the preceding year.
Total adult and children days covered by the Service in British Columbia public hospitals
in 1958 was 2,192,178, an increase of 115,842 days over 1957. A total of 221,315
B.C.H.I.S. adult and children patients were discharged from British Columbia public
hospitals in 1958, an increase of 11,830 over the previous year.
On pages 32 to 36, graphs, prepared by the Research Division of the British Columbia Hospital Insurance Service, depict data compiled from the individual admission-
discharge records received for each person hospitalized for acute care in British Columbia
during 1957.
Table I.—Patients Discharged and Days of Care and Proportion Covered by
British Columbia Hospital Insurance Service, 1949-58
B.C. Public Hospitals
Total Hospitalized
Covered by B.C.H.I.S.
Adults and
Children
New-born
Total
Adults and
Children
New-born
Total
Patients discharged—
1949    .	
164,964
172,645
181,160
188,355
200,893
206,992
216,743
227,359
228,917
235,878
26,272
26,205
27,096
28,675
30,712
31,984
33,190
35,118
37,376
38,570
191,236
198,850
208,256
217,030
231,605
238,976
249,933
262,477
266,293
274,448
140,168
144,959
150,116
154,336
169,167
189,713
199,774
208,293
209,485
221,315
84.9
84.0
82.9
81.9
84.2
91.7
92.2
91.6
91.5
93.8
1,430,646
1,476,615
1,467,102
1,569,974
1,712,878
1,954,823
2,005,165
2,041,854
2,076,336
2,192,178
85.0
83.6
81.7
81.9
83.9
90.4
91.2
91.2
91.2
93.6
24,640
23,943
24,172
25,023
27,830
29,483
31,515
33,174
34,963
36,939
93.8
91.4
89.2
87.3
90.6
92.2
95.0
94.5
93.5
95.8
200,585
193,307
187,891
184,160
197,100
213,587
212,514
217,252
223,079
233,487
93.8
90.8
87.7
85.8
89.5
94.5
93.3
93.1
92.6
95.4
164,808
1950   -                           	
168,902
1951    .. .                          	
174,288
1952     ..
1953   	
1954
179,359
196,997
219,196
1955.  	
1956                              —.
231,289
241,467
19571                	
244,448
19582-   ~ -   	
Percentage of total, patients discharged—
1949
258,254
86.2
1950
84.9
1951
	
83.7
1952
-
82.6
85.1
91.7
1955
92.5
92.0
91 8
19582
	
94.1
Patient-days—
1949         -	
1,682,196
1,766,680
1,795,438
1,916,486
2,041,615
2,162,002
2,198,863
2,239,646
2,277,567
2,343,273
213,874
212,979
214,285
214,701
220,208
226,031
227,674
233,402
240,872
244,766
1,896,070
1,979,659
2,009,723
2,131,187
2,261,823
2,388,033
2,426,537
2,473,048
2,518,439
2,588,039
1,631,231
1950 	
1,669,922
1951              	
1,654,993
1952     	
1,754,134
1953                             	
1,909,978
1954	
2,168,410
1955     	
2,217,679
1956   ....             .   	
2,259,106
2,299,415
2,425,665
86.0
19571         	
19582     .
Percentage of total, patient-days—
1949 --            	
1950              	
	
84.4
1951      	
82.3
1952
82.3
1953	
	
	
84.4
1954   .
90.8
1955
91 4
1956 -	
91 3
19571  	
91 3
1958 2	
93 7
1                      1
1 Amended as per final reports received from hospitals.
2 Estimated, based on hospital reports to November 30th, 1958. Y 30
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, 1949-58.
B.C.H.I.S
. Patients
Total
B.C. Public
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 	
149,280
154,643
159,739
164,379
180,149
199,974
209,999
219,218
221,680
235,165
1,498,121
1,564,222
1,551,954
1,663,149
1,814,344
2,046,087
2,100,386
2,141,445
2,186,437
2,330,128
10.03
10.11
9.71
10.12
10.07
10.23
10.00
9.77
9.86
9.91
24,989
24,336
24,587
25,492
28,381
29,761
32,035
33,783
35,818
37,889
203,197
196,333
190,948
187,923
200,738
215,507
215,980
221,022
229,676
240,472
8.13
8.07
7.76
7.37
7.07
7.24
6.74
6.54
6.41
6.35
140,168
144,959
150,116
154,336
169,167
189,713
199,774
208,293
209,485
221,315
1,430,646
1,476,615
1,467,102
1,569,974
1,712,878
1,954,823
2,005,165
2,041,854
2,076,336
2,192,178
10.21
10.19
9.77
10.17
10.13
10.30
10.04
9.80
9.91
9.91
24,640
23,943
24,172
25,023
27,830
29,483
31,515
33,174
34,963
36,939
200,585
193,307
187,891
184,160
197,100
213,587
212,514
217,252
223,079
233,487
8.14
8.07
7.77
7.36
7.08
7.24
6.74
6.55
6.38
6.32
7,093
7,617
7,308
7,431
8,173
7,602
8,313
9,473
10,118
11,662
45,960
65,326
62,771
68,892
75,518
66,960
75,599
79,428
91,652
117,270
6.48
8.58
8.59
9.27
9.24
8.81
9.09
8.38
9.06
10.05
151
173
171
161
229
199
361
457
673
736
1,146
1,288
1,155
974
1,353
1,251
2,271
2,740
5,100
5,378
7.59
7.44
6.75
6.05
5.91
6.29
6.29
6.00
7.58
7.31
2,019
2,067
2,315
2,612
2,809
2,659
1,912
2,050
2,077
2,188
21,515
22,281
22,081
24,283
25,948
24,304
19,622
20,163
18,449
20,680
10.66
10.78
9.54
9.29
9.24
9.14
10.26
9.84
8.88
9.46
198
1950  _	
1951                  .	
220
244
1952  	
1953	
1954   	
308
322
79
1955	
159
1956	
159
19571	
182
1958= 	
Patient-days—
1949	
214
1,466
1950...	
1,738
1951                  	
1,902
1952    .
2,789
1953	
1954	
2,285
669
1955  	
1956....	
1,195
1,030
19571
1,497
1,607
7.40
7.90
19582  	
Average days of stay—
1949   	
1950 	
1951 --	
7.79
1952    - 	
1953                       	
9.06
7.10
1954     	
8.47
1955
7.52
1956... -	
19571.. 	
19582	
6.48
8.23
7.51
1 Amended as per final reports received from hospitals.
2 Estimated, based on hospital reports to November 30th, 1958.
Estimated patient-days (including new-born days) per thousand of population covered by British Columbia Hospital
Insurance Service: 1949, 1,528; 1950, 1,548; 1951, 1,496; 1952, 1,527; 1953, 1,600; 1954, 1,733; 1955, 1,720; 1956,
1,688; 1957, 1,626; 1958, 1,665. (1954 and subsequent years based on assumption that total population is covered by
British Columbia Hospital Insurance Service.)   Population figures revised according to latest census figures. HOSPITAL INSURANCE SERVICE,  1958
Y 31
Table IIb.—Summary of the Number of B.C.H.I.S. In-patients and
Short-stay Patients, 1949-58
Total Adults,
Children, and Newborn In-patients
Estimated Number
of Emergency and
Minor-surgery
Patients
Total Receiving
Benefits
1949                                      	
174,269
178,979
184,326
189,871
208,530
229,735
242,034
253,001
257,498
273,054
29,000
44,502
47,656
46,767
52,582
63,621
70,553
76,375
83,530
91,883
203,269
1950                                       	
223,481
1951                    	
231,982
1952              -	
236,638
1953                                   —                   	
261,112
1954                                   ~    — -	
293,356
1955 - 	
312,587
1956                                                  	
329,376
19571     - 	
19582  	
341,028
364,937
2,191,297
606,469
2,797,766
1 Amended as per final reports from hospitals.
2 Estimated, based on hospital reports to November 30th, 1958.
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 1958.1
Bed Capacity
Total
250 and
Over
100 to 249
50 to 99
25 to 49
Under 25
Special
Hospitals
Patients discharged—
221,315
36,939
2,192,178
233,487
9.91
6.32
81,464
11,650
1,015,486
79,756
12.47
6.85
41,794
7,786
379,855
48,578
9.09
6.24
49,909
10,870
422,353
64,878
8.46
5.97
29,017
4,241
228,369
25,042
7.87
5.90
13,067
1,717
92,285
10,496
7.06
6.11
6,064
675
Patient-days—
Adults and children  	
53,830
4,737
Average days of stay—
8.88
7 02
1 Estimated, based on hospital reports to November 30th, 1958.
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 1958.1
Bed Capacity
Total
250 and
Over
100 to 249
50 to 99
25 to 49
Under 25
Special
Hospitals
Patients discharged—
Adults and children  	
100.00
100.00
100.00
100.00
36.82
31.53
46.31
34.14
18.88
21.08
17.33
20.81
22.55
29.43
19.27
27.79
13.11
11.48
10.42
10.73
5.90
4.65
4.21
4.50
2.74
1.83
2.46
2.03
Patient-days—
Adults and children	
Estimated, based on hospital reports to November 30th, 1958.  HOSPITAL INSURANCE SERVICE, 1958
Y 33
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AV
^r
\Lb Y 36
BRITISH COLUMBIA
Congenital
^3 Malformations
Allergic, Etc.
^ Neoplasms
Circulatory
2 System
d Symptoms,
Senility, Etc.
Respiratory
2j1 System
Supplementary
Classifications
Digestive
System
Genito-Urinary
3 System
Average Length of Stay of
Patients in Acute-care Hospitals
in British Columbia by
Major Diagnostic Categories
(Excluding New-borns) 1957 HOSPITAL INSURANCE SERVICE,  1958 Y 37
STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR THE
FISCAL YEAR ENDED MARCH 31st, 1958
Administration—
Salaries—Permanent   — ----- $339,303.55
Temporary assistance   9,060.05
Sub-total, Salaries   $348,363.60
Office expense  21,421.03
Travelling expense   25,980.61
Office furniture and equipment  1,665.43
Printing and publications  9,993.80
Tabulating and rentals   1,827.25
Incidentals and contingencies  1,203.61
Technical surveys  1,629.68
Payments to hospitals—
Claims    $32,417,676.40
Vancouver General Hospital re out-patients  ("Hospital Insurance Act," sec. 35 (30))  177,699.35
$412,085.01
$32,595,375.75
Less collections, third-party liability  156,129.56
Grants in aid of construction and equipment of hospitals     $5,737,193.21
Less payable from Hospital Construction Fund       1,572,235.91
32,439,246.19
4,164,957.30
$37,016,288.50
Less Provincial per diem grants (" Hospital Act," sec. 4(1))     $1,764,102.90
Less municipal per diem grants (" Hospital Act," sec. 32 (1)).—      1,146,335.89
Less registration fees ("Hospital Insurance Act," Reg. 8)   11,658.75
Less transfer vote 142h—Salary Revision  19,382.82
       2,941,480.36
Total. Hospital Insurance Service  $34,074,808.14
Certified correct and in accordance with the Public Accounts for the fiscal year ended March 31st
1958.
C. J. Ferber, C.A.,
Comptroller-General.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1959
500-958-2658   

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