PROVINCE OF BRITISH COLUMBIA HOSPITAL INSURANCE ACT Eleventh Annual Report British Columbia Hospital Insurance Service JANUARY 1st TO DECEMBER 31st 1959 Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1960 Victoria, B.C., January 28th, 1960. 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 Eleventh Annual Report of the British Columbia Hospital Insurance Service covering the calendar year 1959. E. C. MARTIN, Minister of Health Services and Hospital Insurance. British Columbia Hospital Insurance Service, Victoria, B.C., January 28th, 1960. The Honourable E. C. Martin, Minister of Health Services and Hospital Insurance, 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 1959. D. M. COX, F.A.C.H.A., Deputy Minister of Hospital Insurance. DEPARTMENT OF HEALTH SERVICES AND HOSPITAL INSURANCE British Columbia Hospital Insurance Service The Honourable Eric Martin, Minister of Health Services and Hospital Insurance. Senior Administrative Staff D. M. Cox, F.A.C.H.A., F.C.I., F.C.I.S., Deputy Minister of Hospital Insurance. L. F. Detwiller, A.F.C., M.A., M.H.A., M.A.C.H.A., M.R.S.H., Assistant Deputy Minister. 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., CM., F.A.C.S., Medical Consultant. K. G. Wiper, Esq., Administrative Assistant. Mrs. G. Whelen, B.Com., Director, Research Division. CONTENTS Page General Introduction 9 B.C.H.I.S. Manual of Policy, Organization and Procedure 10 British Columbia's Plan Subject of Numerous Studies 11 The Hospital Insurance Act 11 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 13 Hospital Benefits Available in British Columbia 14 In-patient Benefits 14 Emergency Services and Minor Surgery 14 Hospital Benefits Available outside British Columbia 14 Organization Chart 16 Organization and Administration 15 Office of the Assistant Deputy Minister of Hospital Insurance 15 Hospital Finance Division 15 Hospital Accounting 17 Hospital Claims 18 Hospital Consultation and Inspection Division 20 Victoria Office 20 Vancouver Office 21 Hospital Construction Division 22 Hospital Projects Completed during 1959 23 Hospital Projects under Construction at Year-end 24 Projects in Advanced Stages of Planning and for Which Working Drawings Are Completed or in the Process of Preparation 25 Additional Projects Developed through Various Planning Stages in 1959 25 Sundry Building Improvement Projects, Including the Installation of Fixed Equipment 25 Medical Consultation Division 25 Administrative Assistant 26 Third Party Liability Section 27 Eligibility Section 27 T 8 BRITISH COLUMBIA Organization and Administration—Continued Research Division 28 General Office 28 Public Information 29 Hospitals as Defined under the Hospital Insurance Act 30 Public Hospitals 30 Outpost Hospitals 31 Federal Hospitals 31 Private Hospitals (Providing General Hospital Services) 31 Statistical Data 32 Table I.—Patients Discharged and Days of Care and Proportion Covered by British Columbia Hospital Insurance Service, 1949-59 33 Table IIa.—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, 1949-59 34 Table IIb.—Summary of the Number of B.C.H.I.S. In-patients and Short- stay Patients, 1949-59 3 5 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 1959 35 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 1959 35 Graphs— Major Diagnostic Categories of Illness, Excluding New-borns, in Acute- care Hospitals in British Columbia, 1958 36 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, 1958 38 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, 1958 39 Average Length of Stay of Patients in Acute-care Hospitals in British Columbia by Major Diagnostic Categories (Excluding New-borns), 1958 40 Distribution of Patient Loads in Hospitals Providing General Service by Type of Clinical Service, 1958 41 Statement of Receipts and Disbursements for the Fiscal Year Ended March 31st, 1959 42 Eleventh Annual Report of the British Columbia Hospital Insurance Service GENERAL INTRODUCTION D. M. Cox, F.A.C.H.A., F.C.I., F.C.I.S., Deputy Minister of Hospital Insurance The British Columbia Hospital Insurance Service completed its eleventh year of operation on December 31st, 1959. This Province's comprehensive hospital insurance programme has resulted in the establishment and maintenance of good and efficient hospital service for the people of British Columbia. The four most important functions of the Hospital Insurance Service are:— To safeguard the residents of the Province from the financial burden associated with hospitalization. Individual health standards have been raised by removing the financial barrier, which otherwise would prevent many people from seeking early hospital care for conditions that might seriously impair their health if neglected. To enable hospitals to improve substantially their service to the public, by assuring them of a steady income. To assist communities to provide adequate facilities by administering the grant-in-aid programme under which the Provincial Government pays 50 per cent of approved hospital-construction costs and 331/- per cent of equipment purchases and building improvements. To help hospitals to establish and maintain high standards of patient-care by providing professional consultative services. Since the inception of the Service on January 1st, 1949, approximately $293,000,000 has been paid toward 3,190,307 hospital accounts. Of those persons in receipt of hospital insurance benefits, 2,455,813 were in-patients in British Columbia's acute-care public hospitals, 706,761 received benefits as emergency or minor surgery out-patients, and 27,733 received benefits after incurring hospital accounts while outside the Province. In addition to this financial aid extended to hospitalized residents, grants for hospital construction and equipment have amounted to approximately $32,000,000. At the present time, payments to British Columbia hospitals by the Hospital Insurance Service are made at the rate of over $115,000 daily for patient-care. During 1959 an estimated 96 per cent of all patients in the Province's 87 acute- care general hospitals received coverage under the Hospital Insurance Service. (This compares with an average of approximately 85 per cent coverage experienced prior to terminating the premium-payment programme on March 31st, 1954.) The remainder were primarily non-residents, Workmen's Compensation Act patients, armed forces personnel, and veterans with pensionable disabilities. The average hospital bill paid by the Service in 1959 was $145. However, beneficiaries are covered for as long as they require hospital care for the treatment of acute conditions, and many individual bills exceeding $5,000 were paid; the largest paid in 1959 amounted to $26,166.20. 9 T 10 BRITISH COLUMBIA From January 1st, 1949, to March 31st, 1954, eligibility for benefits was dependent upon individual premium payments. Effective April 1st, 1954, this plan was terminated, the registration of residents was discontinued, and twelve months' consecutive residence within the Province became the determining factor for eligibility. On July 1st, 1958, the elegibility period for entitlement to benefits was reduced to three consecutive months' permanent residence in British Columbia, when the Province became a participating member of the Federal-Provincial hospital insurance programme. Prior to April 1st, 1959, the British Columbia Hospital Insurance Service operated as one of the three branches of the Department of Health and Welfare. On March 20th, 1959, this Department was reorganized to comprise three branches, namely, Health, Mental Health Services, and Hospital Insurance—and its name was changed to the Department of Health Services and Hospital Insurance. At the same time the Hospital Insurance Commissioner's title was changed to Deputy Minister of Hospital Insurance and the Assistant Commissioner became the Assistant Deputy Minister. The continuing development of the Federal-Provincial hospital insurance programme required frequent correspondence and conferences with the Federal authorities, including visits of Federal staff to Victoria and trips by B.C.H.I.S. personnel to Ottawa. During 1959 the Minister of National Health and Welfare set up an Advisory Committee on Hospital Insurance and Diagnostic Services with representatives from all participating Provinces. The meetings of the Committee replace the former Federal-Provincial Technical Conferences on Hospital Insurance. The Deputy Minister of Hospital Insurance and the Manager of the Hospital Finance Division were named as B.C. members of that Committee, with the Administrative Assistant serving in an advisory capacity. In addition, the Federal Minister made provision for technical subcommittees. The Assistant Deputy Minister and the Director of the Research Division were designated as B.C. members of the Subcommittee on Quality of Care, Research, and Statistics. Reports relating to the activities of the various divisions of the Service appear elsewhere. B.C.H.I.S. MANUAL OF POLICY, ORGANIZATION, AND PROCEDURE From the beginning of the British Columbia Hospital Insurance Service, all policies and procedures relating to hospitals had been outlined in a series of circular letters which were retained on hospital files. It became apparent that there was a need to consolidate all these instructions into a compact manual. A request of this nature was contained in a resolution passed at the Forty-first Annual Convention of the B.C. Hospitals Association in October, 1958. Wishing to co-operate with hospitals through their association, the British Columbia Hospital Insurance Service commissioned Mr. J. A. M. Moir to prepare a comprehensive manual on policy, organization, and procedure. Mr. Moir, former supervisor of the Hospital Claims Section and presently attending the University of British Columbia, co-ordinated the preparation of the manual during the summer months, with the assistance of the division managers and other senior personnel. Copies of the completed manual, comprising 220 pages of letter-size paper, were distributed to hospitals in October. In addition, extracts from the manual dealing with hospital construction and admitting procedures were bound under separate cover for use by hospital planning boards and admitting staffs. Future changes to the manual will be made on loose-leaf paper to facilitate permanent maintenance, and will be forwarded to all manual-holders under cover of a serial letter of instruction. HOSPITAL INSURANCE SERVICE, 1959 T 11 The manual will be of considerable assistance to hospital personnel in the interpretation and implementation of B.C.H.I.S. policies and procedures. Numerous hospital administrators and administrative heads of other Provincial plans have complimented the British Columbia Hospital Insurance Service on the preparation of the comprehensive manual. BRITISH COLUMBIA'S PLAN SUBJECT OF NUMEROUS STUDIES British Columbia is considered a " pioneer " in the field of hospital insurance, being the second Province in Canada to initiate such a programme and having completed eleven years of successful operation. As a consequence, representatives of numerous countries and planning organizations have expressed considerable interest in the administration and operation of the Province's plan, and the British Columbia Hospital Insurance Service is often " host" to delegates on fact-finding missions. In the past two years the Service has been visited by representatives from the British Ministry of Health, the National Health Service of Chile, the Republic of Indonesia, and the Government of Puerto Rico, as well as numerous visits from Governmental officials of several of the Provinces and the Government of Canada. The following list of visitors to the Service during 1959 is indicative of the continuing interest in British Columbia's plan for hospital insurance coverage:— March: Mr. W. J. Brown, Deputy Commissioner of the Northwest Territories, and his assistant, Mr. R. J. Orange. April: Col. Laval Fortier, O.B.E., Q.C., Deputy Minister of Citizenship and Immigration of the Government of Canada. June: Mrs. Palmira Loyola de Lopez, representing the Government of Puerto Rico, and Dr. Gabriela Venturini, of the School of Public Health, Santiago, Chile. July: Dr. E. H. Lossing, M.D., M.P.H., Dr. J. H. Horowics, LL.D., and Mr. J. E. Sparks, from the Department of National Health and Welfare. September: A group of students from Iran studying at the University of Southern California; Miss F. McCubbin, of the School of Social Work, University of British Columbia; and Dr. Matthew Ross, medical director of the American Psychiatric Association, and Dr. H. Vaughan. October: Mr. K. S. McLaren, representing the extension course on "Hospital Administration and Management," of the University of Toronto. November: Miss Maja Van Steensel, chief of the Dutch section of the C.B.C. international service, from Montreal. December: Arrangements were being completed at the request of Dr. Louis S. Reed, Ph.D., Associate Professor of Medical Economics at Cornell University, Ithica, N.Y., for a visit early in January. 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. T 12 BRITISH COLUMBIA (3) Benefits include standard ward accommodation, food and general nursing services, the use of the operating-room, caseroom, 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 Deputy Minister 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 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 INSURANCE SERVICE, 1959 T 13 hospital services, such as X-ray, laboratory, operating-room, etc., provided to patients, in addition to bed, board, and nursing care. 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 denned 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. 27). 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 Deputy Minister of Hospital Insurance 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 (_>) 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. 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 (£>) 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 T 14 BRITISH COLUMBIA (/) 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 caseroom 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 Deputy Minister of Hospital Insurance 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 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. Else- HOSPITAL INSURANCE SERVICE, 1959 T 15 where, payment will be made at a rate not exceeding $12 per day ($4 for newborn 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 The British Columbia Hospital Insurance Service is a branch of the Department of Health Services and Hospital Insurance. The administrative head is the Deputy Minister of Hospital Insurance. The following reports give a brief outline of the work carried out by the office of the Assistant Deputy Minister and by the various divisions and sections which comprise the administrative structure of the branch. Office of the Assistant Deputy Minister of Hospital Insurance L. F. Detwiller, A.F.C., M.A., M.H.A., M.A.C.H.A., M.R.S.H. In addition to routine administrative work, including personnel management and liaison with the Civil Service Commission, during the year this office conducted several studies and also took part in conferences held in Ottawa relative to the Federal-Provincial hospital insurance plan. In this regard, the incumbent is a member of the working party of the Sub-committee on Quality of Care, Research, and Statistics, which has been established to review and make recommendations on terminology, statistical data, etc., in order to establish uniformity in these fields across Canada. Early in the year a survey of the hospital facility requirements of the Lower Mainland was commenced and was still under way at the year-end. Primary analyses brought some interesting facts forward, which resulted in additional information being required in connection with the number of beds likely to be required in Greater Vancouver for patients referred from other parts of the Province. The British Columbia Division of the Canadian Medical Association and the Faculty of Medicine at the University of British Columbia are conducting surveys which deal with this problem. In addition, a metropolitan hospital committee has been formed in Greater Vancouver which will work in co-operation with the Hospital Insurance Service in analysing the hospital-bed allocations for the area. This office also worked in conjunction with other divisions of the Hospital Insurance Service in reviewing the Provincial infirmary programme. Hospital Finance Division W. J. Lyle, F.I.C.S, Manager The Hospital Finance Division performs two main functions—hospital accounting and payment of hospital claims. The Division is also responsible for the approval of equipment grants, and in 1959 recommended grants of over $600,000, after a review of 4,000 applications received from hospitals. During 1959 the Division Manager was appointed to the Advisory Committee on Hospital Insurance and Diagnostic Services, which is an advisory body to the Minister of National Health and Welfare. Two meetings were attended in Ottawa. Federal policies in 4 T 16 BRITISH COLUMBIA o-_ a 2 3 £ ffl 0 z o I—I H < o Pi o 3 a „ M c'S p, w <! IP Z M ^ <o cfl'55 £5 _e 3° _. C V •5_0 l-l >1 _, III a § .23 cfl ta e III OB lis 5 c° * o o a-.5 .__■-.„ p_it —- — S1JS a a c o Q g [fl ffi a o u a HOSPITAL INSURANCE SERVICE, 1959 T 17 respect to sharing the 1958 cost of equipment grants and payments to contract, Federal, and out-of-Province hospitals were such that the Federal Government would have paid only one-half of its obvious share of these costs. During the meetings in Ottawa and through correspondence, strong representations were made for a revision of these policies. The Service received assurance that an adjustment will be made for 1958 which will result in the sharing of these payments on an equitable basis. It is estimated that this will increase the Federal payments relating to 1958 hospital costs in British Columbia by at least $300,000. During 1959, groups of officials from Ottawa, representing the Federal Departments of Finance, and Health and Welfare, visited the British Columbia Hospital Insurance Service on three occasions to develop estimates of hospital costs, review the situation in British Columbia, and determine what hospital services would qualify as shareable under the agreement. The methods and procedures to be used in arriving at shareable costs, particularly as they related to 1958 (a part year under the agreement), involved considerable discussion and negotiation. The Division Manager continued to perform duties as a member, and secretary, of the Hospital Rate Board and to represent the British Columbia Hospital Insurance Service on the Radiology Advisory Council, which acts in an advisory capacity on the development of radiology services and purchase of equipment by general hospitals. The following is an outline of the duties, activities, and responsibilities of the two sections of the Finance Division: — 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 visits to hospitals to review financial and statistical records and procedures. These visits, extending from three days to three weeks, were made to eighty-five public hospitals during 1959. Accounting assistance and instruction were also provided on request to smaller public hospitals in the Province. Other functions performed by the Hospital Accounting staff included:— (a) The tabulation of monthly statistical and financial reports from hospitals and the correlating of these with the approved budgets. (b) The determination of 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 and the Department of National Health and Welfare. (d) The carrying-out of accounting inspections and cost studies of nursing homes and chronic institutions upon the request of the Social Welfare Department for welfare payment purposes. (e) The auditing of accounts of hospital-construction projects to determine the amount of construction grants payable by the Province. During 1959 fifteen completed construction projects, involving an expenditure of over $10,500,000, were audited and the required statements prepared for the Federal Government in order that Federal construction grants could be claimed by the hospitals. Experience during the first few years' operation of the British Columbia Hospital Insurance Service indicated that operating costs required serious consideration when planning new hospitals and additions to existing hospitals. In order to ensure that T 18 BRITISH COLUMBIA 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 area. These estimates are submitted to the British Columbia 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 addition 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 the hospital board to revise its 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 British Columbia 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 sharing of hospital costs by the Federal Government from July 1st, 1958, 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. This has also required changes in the accounting system of British Columbia hospitals, involving more detailed Departmental financial accounts and an extension of statistical requirements. Close liaison with Federal Health and Treasury Department officials was maintained and procedures developed for further co-operation. During the year our accounting staff reviewed hospital operating statements for 1958 and prepared the required schedules for submission to the Federal Treasury auditors for eighty-four public hospitals. As the Federal hospital insurance sharing arrangement is complex, particularly for a part year, this procedure called for a considerable amount of detailed work, in order that the numerous items of revenue and expenditure which are not shareable under the agreement might be accurately determined and deducted from each hospital's operating expenses. In co-operation with the Comptroller-General for British Columbia, monthly claims, covering payments already made by the Province, were prepared and forwarded to Ottawa. The 1958 Annual Report on Hospital Statistics for British Columbia was prepared by this office. Hospital Claims W. J. Wade, Supervisor During the year, in addition to the routine work described on the following pages, this staff undertook to consolidate all instructions to hospitals for the completion of the admission-discharge form so that an initial chapter of a proposed manual for hospitals could be written. This work was commenced in March and the completed draft presented in June. Further portions of the manual subsequently were prepared in respect to other matters involving hospital accounts and procedures. The Hospital Claims staff is responsible for processing all admission-discharge records which hospitals submit for each patient, and approving for payment all acceptable claims. Every claim is checked by this office, whether it is payable by the British Columbia Hospital Insurance Service or by the patient or other agency. Approximately 1,300 claims were processed each working-day during 1959. HOSPITAL INSURANCE SERVICE, 1959 T 19 The sections participating in this work and a brief outline of their duties follow. 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 are checked with the verifying documents. Discrepancies may be checked either with the hospital concerned or by referral for investigation by 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 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, such as the British Columbia Hospital Insurance, the Workmen's Compensation Board, the Department of Veterans' Affairs, or perhaps another Province having a plan in force. During the year a total of 290,709 accounts were paid, compared with 274,694 in 1958 and 257,398 in 1957. A good portion of the increase of 26,015 resulted from the adoption of a three-month residence requirement from July 1st, 1958, prior to which a twelve months' residence was required to obtain insurance benefits. The larger number of accounts paid can also be attributed to the British Columbia Hospital Insurance Service accepting responsibility for bills incurred by recipients of war veterans' allowance, sick mariners, and others, whose hospital care prior to the signing of the Federal-Provincial Hospital Insurance Agreement was a responsibility of the Federal Government. The increase in the number of hospital beds during the year was another contributory factor. The Social Welfare Records Section maintains an alphabetical file of all health services identity cards issued to welfare recipients for this Province. Hospital accounts incurred by welfare patients are checked against this file to determine eligibility for hospital benefits. This file is used as a source of reference by the Department of Social Welfare. The Vouchering and Key-punch Sections are responsible for batching and voucherins checked accounts in order to determine the amounts payable to each hospital, and for the preparation of I.B.M. cards to record statistical, financial, and medical data. Approximately 2,000 cards were processed daily, which formed the basis from which this office prepared tabulated listings of accounts paid to hospitals. The Out-of-Province Section administers the screening and pavment of accounts incurred bv B.C. residents in hospitals outside the Province. This includes obtaining an Application for Benefits and establishing that the patient is entitled to have payment made on his behalf. Diirinrr 1959 a total of 2,910 accounts, amounting to $351,750 were p^'d on behalf of qualified residents who were hospitalized in other Provinces of Canada, the United States, Mexico, British West Indies, the United Kingdom, Eire, Australia, France, Switzerland, Italy, Holland, West Germany, Norway, Denmark, Sweden, Hong Kong, and Japan. The commencement of hospital insurance plans in other Provinces under the Federal Hospital Insurance and Diagnostic Services Act resulted in certain problems related to the pavment of out-of-Province accounts. These payments are now made at the standard per diem rates established by the Province concerned (less the $l-a-dav charge) as compared to the previous flat rate for all out-of-Province hospitals. Hospital insurance plans were previously in effect in Alberta, Saskatchewan, Manitoba, and Newfoundland, and during 1959 the following commenced T 20 BRITISH COLUMBIA operations: Ontario, January 1st, 1959; Nova Scotia, January 1st, 1959; New Brunswick, July 1st, 1959; and Prince Edward Island, October 1st, 1959. The Filing Section sorted and filed an average of 4,000 forms and letters daily. Patients' records for the year 1958 were microfilmed by the Central Microfilm Bureau of the Provincial Library: 846,872 documents were processed, using 29,000 feet of film. An additional 1,900 feet of film was used to process out-of- Province accounts and rejected claims. This use of a microfilm eliminated the need for approximately sixty steel filing-cabinets. It also provided the Service with a set of duplicate records by running two copies of the film. The Hospital Claims office continued to maintain close co-operation with the Medical Consultant's staff, obtaining technical advice on medical data for all in- Province and out-of-Province claims. Hospital Consultation and Inspection Division J. W. Mainguy, M.H.A., Manager This Division consists of two offices—the Victoria office, which is chiefly concerned with work related to the Province's approved public hospitals, and the Vancouver office, whose major activity is in connection with the licensing and inspection of private hospitals. Victoria Office During 1959 this office was involved in a variety of activities, which included visits to hospitals; the analysis related to budget preparation carried out in conjunction with the Finance Division; the review of draft by-laws with the Administrative Assistant; the provision of tabulated wage-rate information and other personnel information to hospitals; assisting in reviewing plans for new hospitals and for renovations; participation in activities related to the responsibilities of the Hospital Rate Board, of which the Manager of the Division is a member; and the provision of information to hospitals and Provincial plans in answer to widely diversified questions on administrative problems. Compared with 1958, there was an increase in the number of inspections made by the Victoria office to private hospitals and a decrease in the number made to general hospitals. The resignation of a Hospital Inspector in mid-year to accept a position at the University of Toronto was a significant factor in the decrease of general hospital inspections, as a replacement could not be secured until late in the year. Thirty-five visits were made to private hospitals to assist the Vancouver office, specifically in the field of nursing care, and forty-seven visits were made to thirty-six public general hospitals, some of which lasted up to four days, and were carried out by two members of the Division. Working in conjunction with the Health Branch, members of this office helped to prepare and to conduct a dietary institute at Prince George, where twenty-four cooks from twenty-two hospitals and institutions which do not have dieticians were in attendance for five days. The course, which stimulated considerable interest, was a successor to the one held at Cranbrook in 1958. Facilities were provided by the Prince George Hospital. The Victoria office also participated in the preparations for the civil defence orientation course for hospital administrators, organized by the Provincial civil defence authorities and held in Victoria in November. Assistance is also being provided for a course for directors of nursing in January, 1960. The Division Manager continued to represent the British Columbia Hospital Insurance Service on the Laboratory Advisory Council, which acted in an advisory capacity on matters related to laboratory services and equipment in general hospitals. In this capacity the Manager participated in a survey by a sub-committee of the Council of regional pathology services in the West Kootenay. HOSPITAL INSURANCE SERVICE, 1959 T 21 A close relationship was maintained with the Provincial Fire Marshal during the year in order that fire safety in hospitals could be improved upon. Members of this Division maintain close liaison with the Health Branch. Contact was made with Medical Health Officers and their staffs in the field; with the Technical Supervisor, Clinical Laboratory Services; and the Technical Adviser of Radiology. During the year the services of a dietician from the Health Branch were made available to the Division, and inspection visits have been carried out to hospitals as the result of close working relations between the dietician and members of this Division. The Division assisted the Hospital Construction Division on a project to develop detailed plans of nurses' stations and utility rooms. Considerable information was obtained from hospitals regarding their drug formularies and methods of developing these. This material was made available to the Faculty of Pharmacy of the University of British Columbia for its continuing survey on pharmacy practices in hospitals, undertaken at the request of the Hospital Insurance Service. A member of the Victoria office is on the Institute Planning Committee for directors of nursing, which will be holding an institute early in 1960 for directors of nursing under the auspices of the Registered Nurses' Association of British Columbia. Assistance was given to the Public Information Office in the preparation and editing of articles of general interest in hospital operation which were printed in the British Columbia Hospital Insurance Service Bulletin. A revised personnel manual was made available to hospitals. Vancouver Office One of the functions of the Hospital Insurance Service is the administration of the Hospital Act, and matters pertaining to hospitals which are licensed under Part II of the Act are handled chiefly through this office. The category " private hospital" includes some small general hospitals, most of which are operated in remote areas by industrial concerns, but includes, chiefly, facilities giving skilled nursing care to the aged sick. Most of these facilities are operated for profit by private operators or companies. This office maintained a continuing programme of food service inspection and consultation, under the guidance of a part-time consulting dietician. A three-week rotating menu pattern was sent to all hospitals to give guidance in the provision of nutritious meals which can be served attractively yet inexpensively. The dietician visited fifty private hospitals during the year. The consulting dietician from this office took an active part in the Food Service Institute in Prince George. In addition to the dietary inspections mentioned above, ninety-two regular inspections and eight special visits were made by this office, and thirty-five additional visits were made by personnel from the Victoria office, making a total of 185 visits to private hospitals during the year by the Division. Provincial and municipal fire, electrical, and sanitary inspectors also carried out inspections. At the request of the Health Branch, a special study was undertaken of the type of patient accommodated and the service provided in the licensed private hospital in Vancouver operated by the British Columbia Cancer Foundation. The study was carried out jointly by personnel from the Victoria and Vancouver offices. Forty-seven new private-hospital beds were licensed in 1959. There were 137 inquiries from persons actively interested in establishing private hospitals. This was an increase of sixty-three over last year. At the year-end there were 130 private-hospital beds under construction, of which eighty-six were beds in new T 22 BRITISH COLUMBIA buildings designed for private-hospital operation. A number of plans for new private hospitals were on the planning boards of architects. Beds in operation at the end of 1959 were: 1,860 beds for the aged and infirm, licensed in fifty-six private hospitals, and 170 beds licensed in seven private acute hospitals, making a total of 2,030 beds. The Manager of the Division has been appointed to the Welfare Institutions Board, and this will help to maintain an even closer liaison between this Division and those involved in the licensing of boarding homes. Another major activity of this office is in the field of hospital clearance. This procedure is a method of moving, from acute general hospitals to more suitable facilities, welfare patients who no longer require the specialized services of an acute general hospital but who do need care beyond that which could be given in their own home. The actual work of placing these people is done by the Department of Social Welfare at the request of this office. In 1959 this office asked Social Welfare to arrange placement for 110 patients. Hospital Construction Division A. W. E. Pitkethley, Manager This Division has three main responsibilities:— (1) Providing a consultative service to general hospitals when planning new hospital facilities, renovations, or additions to existing buildings. (2) Processing and recommending for approval applications for Provincial grant assistance toward the cost of capital construction and improvements. Preparing applications for submission to the Federal Government for Federal grants toward the cost of construction projects. (3) The administrative supervision of the Marpole Provincial Infirmary, in Greater Vancouver, and the branch in Victoria and Haney. (The Manager of this Division serves as secretary of the Advisory Board of Management of the Provincial Infirmaries.) These institutions have a total bed capacity of 283 beds, and during the year had occupancies ranging from 80.6 to 83.7 per cent. A great deal of time is spent reviewing plans of proposed new facilities forwarded by hospitals. Special attention is given to the design and layout of each building to ensure that it can provide an excellent standard of patient-care, efficient and economical operation, and adequate service and clinical facilities for potential future expansion. With the co-operation of other divisions of the Hospital Insurance Service and the Health Department, hospital boards are provided with a complete consultative service. Assistance is secured from the Consultation and Inspection Division and the Finance Division and Research Division of the British Columbia Hospital Insurance Service, as well as the Division of Public Health Engineering, the Consultant in Nutrition, the technical adviser to the Laboratory Advisory Council, the technical adviser to the Radiological Advisory Council, and the Public Health Officers, all of the Provincial Department of Health. In addition, the Professor of Paediatrics of the Department of Medicine of the University of British Columbia gave valuable assistance in reviewing plans for paadiatric and nursery facilities. The chief of the Hospital Design Division of the Federal Government gave advice on selected problems in hospital design. Consultant services on selected engineering problems were also available to this Division, through the co-operation of the Provincial Public Works Department. During the year, arrangements were concluded with the Provincial Public Works Department whereby architectural and drafting services were allocated to HOSPITAL INSURANCE SERVICE, 1959 T 23 this Division. Intensive study has been given to various components of hospital design and layout, and in particular a detailed survey and study was undertaken of the layout of nursing units. To assist in making the study, a seventy-page questionnaire was circulated to representative hospitals asking for comments and observations from hospital personnel at the nursing level. The valuable information contained in the answers to the questionnaire is at present under study, but has already been used as a basis for developing sketches for the hospitals and the architects retained by them. The Division maintained liaison with the Hospitals Committee of the British Columbia Medical Association, which is co-operating in the study of selected problems referred to it. Special study committees were set up by the Registered Nurses' Association of British Columbia to study and report, from a nursing view-point, on projects referred to them by the Hospital Construction Division. These projects include a study of nursing units and nurses' stations and the concept of " progressive patient- care." The Architectural Institute of British Columbia has formed a hospital committee as a liaison body to work with the British Columbia Hospital Insurance Service on special problems, such as the relationship of architects and their consultants, and the interpretation to be placed on the terms respecting their conditions of engagement. The number of inspection trips to hospitals carried out by this Division increased considerably over previous years. (a) Hospital Projects Completed during 1959 Surrey Memorial Hospital.—The new hospital, officially opened on January 31st, 1959, was originally planned to provide 62 beds, with space for an additional 44 beds left in an unfinished state. However, before the end of 1959 the tremendous growth of the area made it necessary to bring 106 beds into operation. Eleven of these beds met a particular need for additional pa_diatric accommodation in the area. Future expansion of this hospital can be achieved by construction of wings to bring the eventual capacity to over 300 beds. Tofino General Hospital.—Early in 1959 the new 9-bed staff residence became available for accommodation. Lillooet District Hospital.—On May 6th, 1959, the official opening was held for the new 16-bed hospital. In addition to the 16 beds, there is unfinished space for 4 additional beds that can be quickly brought into operation when necessary. A separate staff residence to accommodate ten persons was also completed. Burnaby General Hospital.—The official opening ceremony for the new addition was held on May 9th, 1959. The wing accommodates 100 active-treatment beds and also provides space for the emergency department, laboratory, physiotherapy facilities, and a new operating suite. The alterations to the existing hospital building were completed in October, 1959, and provided a net gain of 23 beds. Prince George and District Hospital.—The new 45-bed staff residence was officially opened on May 13th, 1959. The residence is a frame-constructed two- story building and is generously provided with recreation and lounge facilities. Chilliwack General Hospital.—The completion of the new wing and the renovations to the former main building were commemorated at an official opening ceremony on June 6th, 1959. The hospital now has accommodation for 146 adults and children, together with 28 bassinets for the new-born. T 24 BRITISH COLUMBIA Bella Coola General Hospital.—The new staff residence was completed in June, 1959. The building replaces the old two-story frame residence and provides accommodation for fifteen hospital employees. Vancouver General Hospital Centennial Pavilion.—The opening and dedication ceremonies for the Centennial Pavilion were held on June 30th, 1959. The construction of this ten-story building commenced in August, 1955. It includes a separate laundry building and emergency department connected to and forming part of the new unit. The bed accommodation and services include 504 acute beds in single and 4-bed rooms, surgeries, a 16-bed recovery ward, X-ray department, laboratory, dietary department, administrative areas, stores, and central sterile- supply department. The hospital also converted its heating-boilers from coal-firing to gas-firing, with oil as a stand-by fuel. Grace Hospital, Vancouver.—On July 3rd, 1959, the new wing was officially opened. This addition to the hospital constitutes the main part of a building programme which included alterations to the existing hospital building and a new boiler-house. The increase in bed capacity totals 44 beds and 55 bassinets, the new wing accounting for 30 beds and 32 bassinets. Kootenay Lake General Hospital, Nelson.—The hospital society took possession of the new 12-bed staff residence on August 1st, 1959. Shuswap Lake General Hospital, Salmon Arm.—This new 50-bed hospital was officially opened on October 9th, 1959. The hospital is a two-story reinforced- concrete building in the form of a modified " T," and has been planned for future expansion to 85 beds. St. Mary's Hospital, New Westminster.—During the latter part of 1959, structural changes were completed at this hospital which made it possible to increase the pa-diatric bed accommodation by 24 beds. The revised capacity figure for the hospital is now 170 A. and C. beds. It is of interest to note that the co-operation of St. Mary's Hospital and the Surrey Memorial Hospital, in providing, at a nominal cost, increased accommodation for paediatrics met a very urgent and immediate need for additional children's beds in the area. Their action also saved the Royal Columbian Hospital expending approximately $300,000 on a Class B type of unit intended to be used for paediatrics on a temporary basis. (ft) Hospital Projects under Construction at Year-end Burns Lake Hospital: New 36-bed hospital building. Golden General Hospital: New 24-bed hospital building. Kimberley and District Hospital: New 48-bed hospital building. King's Daughters' Hospital, Duncan: Addition for a recovery ward. Kitimat General Hospital: New 82-bed hospital, plus accommodation for thirty-nine hospital employees. (Note.—The initial patient accommodation at this hospital has been reduced from 113 to 82 beds. This reduction is a result of a cutback in expansion plans of the Aluminum Company of Canada.) Lions Gate Hospital, North Vancouver: Construction of a new 283-bed hospital. Prince George and District Hospital: A new 125-bed hospital. St. Joseph's General Hospital, Dawson Creek: A new 60-bed hospital building. Vancouver General Hospital: Mechanical services project. HOSPITAL INSURANCE SERVICE, 1959 T 25 (c) Projects in Advanced Stages of Planning and for Which Working Drawings Are Completed or in the Process of Preparation Matsqui-Sumas-Abbotsford General Hospital, Abbotsford: Completion of 17 additional beds. Nanaimo General Hospital: 158 beds. Royal Columbian Hospital, New Westminster: Nurses' residence and training- school, and new laundry building. Royal Jubilee Hospital, Victoria: 64 additional beds, plus areas for diagnostic treatment facilities. Terrace and District Hospital: 40 beds. Vancouver General Hospital: Construction of combined locker area; alterations to physical medicine department. Wrinch Memorial Hospital, Hazelton: Addition for emergency and administration areas. (d) Additional Projects Developed through Various Planning Stages in 1959 Children's Hospital, Vancouver: Expansion plans. Langley Memorial Hospital, Murrayville: Expansion programme. Mater Misericordias Hospital, Rossland: Demolition of old wing and replacement of essential facilities. McBride and District Hospital: 21 beds. Mission Memorial Hospital: 54 beds. Nicola Valley Hospital, Merritt: New hospital. Powell River General Hospital: Expansion plans. Providence Hospital, Fort St. John: 60 beds. Royal Inland Hospital, Kamloops: Alterations and additions to bring capacity up to 230 beds. St. John Hospital, Vanderhoof: Addition. St. Joseph's Hospital, Victoria: 31 additional beds, plus alterations to existing building. St. Paul's Hospital, Vancouver: Laboratory department and laundry addition. Vancouver General Hospital: Renovation of Laurel Pavilion. Vernon Jubilee Hospital: Addition to provide 21 additional beds. War Memorial Hospital, Williams Lake: 70 beds. (e) Sundry Building Improvement Projects, Including the Installation of Fixed Equipment During the year this Division processed almost 250 applications for grants to assist in financing the cost of structural improvements and building alterations, including fixed equipment. The cost of these projects totals approximately $183,000, and ranged in cost from over $25,000 to less than $50. Medical Consultation Division W. A. Fraser, O.B.E., E.D., M.D., CM., F.A.C.S., Medical Consultant Under the Hospital Insurance Act and regulations, benefits are available to qualified persons admitted to hospital upon recommendation of the attending physician. Each admission to hospital is subject to a medical eligibility review, which is one of the main responsibilities of the Medical Consultant's Division, with particular attention being paid to length of stay in hospital of patients receiving hospital insurance benefits. For statistical purposes this Division is also responsible for the check- T 26 BRITISH COLUMBIA ing and accurate coding of the diagnoses and other pertinent medical data on the discharge records. The work of coding according to the Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death has been made more efficient by the addition of two medical coders, making a total of five. This has made it possible to furnish the Research Division with additional information concerning bed distribution in the Province. A breakdown of the discharge diagnoses into bed services, such as adult medical, adult surgical, obstetrical, new-born, pa_diatric medical, pediatric surgical and psychiatry, has been instituted. This information has been of considerable value to the Research and Hospital Construction Divisions in determining bed requirements in areas where new hospital construction is contemplated. Comparative studies were carried out on the length of stay in five of the larger hospitals in the Province, and assistance was given to a survey of patient transfers being carried out to determine Lower Mainland hospital requirements. Posting of all alcoholic admissions to hospitals throughout the Province is maintained to establish the number of apparent cures. Early in January, 1959, negotiations were started with the College of Physicians and Surgeons of British Columbia and the Canadian Medical Association, British Columbia Division, for the setting-up of a Medical Consultation Board. On April 17th, 1959, Order in Council No. 784 authorized the establishment of a Medical Consultation Board to consist of four medical practitioners " for the purpose of reviewing and advising on questions of medical eligibility for hospital insurance benefits and other medico-administrative matters affecting the operation of the British Columbia Hospital Insurance Service." Undoubtedly, this Consultation Board will prove of great assistance to the Medical Consultant. Recently the Vancouver General Hospital appointed an administrative assistant —medical, whose duties will include answering queries concerning hospital admissions and medical eligibility for hospital insurance benefits. Due to the size of the hospital and its position as the principal teaching unit of the Medical Faculty, this appointment should be of advantage to the Medical Consultant's Division and will result in a more efficient method in handling hospital claims of the Vancouver General Hospital. Mrs. Margaret Morrison, Assistant to the Medical Consultant, successfully completed a two-year extension course to qualify as a medical record librarian. As this Division deals extensively with hospital medical record departments, Mrs. Morrison's qualifications will result in a better liaison with the various hospital staffs and medical record librarians. 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 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 is 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. HOSPITAL INSURANCE SERVICE, 1959 T 27 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 constructing and improving hospital facilities in the area. At the end of 1959 there were twenty-six such districts in operation and a number of others in the process of formation. Descriptive material outlining the procedure for establishing such a district is supplied upon request to interested groups. During 1959 considerable time was spent on matters connected with the Federal-Provincial hospital insurance plan. Statutes, regulations, and the Federal- Provincial agreement were amended and extensive discussions were held with officials of the Federal Government and other Provincial plans to remove administrative difficulties and provide for better liaison. This official was also a member of the editorial board which edited the manual described elsewhere in this Report and is responsible for co-ordinating the processing of future amendments to this manual. The Administrative Assistant is responsible for over-all supervision of the Eligibility and Third Party Liability Sections. 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. Eligibility Section In order to ensure that only qualified British Columbia residents receive hospital insurance benefits, the staff of the Eligibility Section review all applications for benefits made by or on behalf of patients admitted to hospital. A detailed check is made of all doubtful applications, resulting in a considerable number of unqualified claims for B.C.H.I.S. benefits being rejected. Eligibility Inspectors visit hospitals on a regular schedule to see the B.C.H.I.S. eligibility procedures are being properly carried out. The Inspectors also assist in the training of new hospital admission and eligibility staff members. In this regard, regional meetings were held in 1959 in a number of centres for the purpose of bringing together hospital personnel for panel discussions dealing with problems connected with the admission of patients to hospital and their status under the Hospital Insurance Act. This Section has provided the great majority of employers in British Columbia with books of employers' certificates. The Inspectors maintain close liaison with these firms to ensure their continuing co-operation in providing their employees with proof of residence for hospital insurance purposes by means of these certification forms. T 28 BRITISH COLUMBIA 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. Research Division Mrs. G. E. Whelen, B.Com., Director The main functions of the Research Division are:— (1) To survey geographic areas within the Province, in order to determine the need and size of new hospital construction. (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 compilation of data which are not directly available from other divisions in the Service. In 1959 reassessments of bed needs were made for the Prince George and District Hospital, the new Fort St. John Hospital, the Matsqui-Sumas-Abbotsford Hospital, the Mission Memorial Hospital at Langley, the new Lions Gate General Hospital in North Vancouver, and the Terrace and District Hospital. A study of the bed needs in the Cariboo region and the McBride area was also completed during the year and the findings published. Statistical tables were completed and referred to the local planning committees in a report entitled " Interim Statistical Tables Pertaining to Hospital Facilities in the Lower Mainland Area." Work is continuing on the study of bed needs in the Southern Okanagan and Central Border region, and the results will be published next year. Many requests for statistical data were received during the year, not only from other divisions in the Service, but also from hospital administrators and unallied organizations such as the Myasthenia Gravis Foundation of Vancouver, the Canadian Arthritis and Rheumatism Society, the Committee on Welfare of the Aged, Community Chest Council of Greater Vancouver, and the British Columbia Safety Council. The Director of Research was sent to Ottawa as a representative of British Columbia to attend the meeting of the Sub-committee on Quality of Care, Research, and Statistics, held in conjunction with the Federal-Provincial hospital insurance plan. The purpose of this Committee was to provide for an exchange of information relating to Provincial experiences and plans and to make decisions regarding the type of Provincial statistical information required under uniform terminology. This will enable the Federal Government to assess health needs on a country-wide basis. The conclusions reached at this meeting and forthcoming meetings will likely result in some reassessment of the work procedures in this Division. General Office C. R. Leighton The General Office is responsible for the recording and accounting of all receipts and expenditures incurred in the administration and operation of the Hospital Insurance Service. All requisitions, vouchers, or warrants emanating from divisions or sections are reviewed by this office and passed to the appropriate Government department for further action. The General Office accounting responsibilities include a check of certain accounts and the preparation of estimates. Departmental purchasing is handled by this Office, which also assumes responsibility for furniture inventories, stock-supplies, HOSPITAL INSURANCE SERVICE, 1959 T 29 operation of the teletype service, operation of office equipment, and the storage and dispatch of forms for hospitals. Certain personnel matters are dealt with by the General Office, and pay and personnel records are kept by the pay clerk. The preparation of Infirmary estimates is supervised by the General Office. Expenditures are controlled by routing all requisitions and vouchers through this office, which also audits the Infirmary accounting and prepared monthly statements of expenditures. The monthly comfort allowance received by all Infirmary patients is paid to Mount St. Mary patients by General Office personnel. This office also acts as liaison between the Mount St. Mary authorities and the Infirmary business manager. Public Information R. H. Thompson It is the responsibility of this office to develop and administer the public information activities of the Service. The following is a brief outline of the methods by which these responsibilities were carried out:— B.C.H.I.S. Bulletin.—The principal purpose of the Bulletin is to serve as an administrative aid to clarify, for hospitals, policy and procedure changes. Regular editions of the Bulletin were distributed to over 100 B.C. hospitals. During the year certain articles of general interest to hospital authorities were included; such as, " Fire Prevention and Training," " Principles for the Purchasing Agent," " Laundry Operation," " The Teen-age Volunteer," etc. Pamphlets.—The pamphlet " Serving You," distributed to hospitals in 1956, was considerably revised and will be reprinted early in the new year under the title "At Your Service." Its main purpose is to assist hospitals in explaining various aspects of the Hospital Insurance Service and hospital routine to the patient. The " General Information " pamphlet was revised in October and in April, and copies were distributed to the general public, hospitals, civic organizations, business firms, etc. Press Releases.—Weekly releases on the Service's grant-in-aid programme were sent to the Province's newspapers and rad'o and television stations. During the year a photographic record was made of each new hospital, by a member of the Photographic Branch of the Department of Recreation and Conservation, in conjunction with the news coverage of the official opening. Articles.—Several articles on various aspects of the Service, such as the extensive hospital-construction programme under way during the year, were prepared for submission to B.C. newspapers and the British Columbia Government News, and regular contributions were submitted each month to The Canadian Hospital, official journal of the Canadian Hospital Association. Displays.—At the request of the executive of the British Columbia Hospitals' Association, a display illustrating the accomplishments of eleven years of hospital insurance was prepared for its forty-second convention in Vancouver. This display was also exhibited at the Public Health Institute held in Victoria in October. Assistance was also provided in the development of a new B.C.H.I.S. exhibit in the British Columbia Building at the Pacific National Exhibition. T 30 BRITISH COLUMBIA Film Library.—Numerous hospitals made use of the 16-mm. sound films for instructional purposes regarding hospital operation and activities. The films are available on a loan basis. Miscellaneous duties included answering letters of general inquiry; writing special material, for example, " Ten Years in Review," "A Community Builds a Hospital," and " Reference Material on B.C.H.I.S." (a comprehensive review of the programme since its inception); supervising the production and distribution of the B.C.H.I.S. manual and subsequent additions; maintaining the newspaper- clipping files; writing material requested by various organizations for use in information pamphlets, etc., and preparing and producing the Eleventh Annual Report. During the year, assistance was given to the office of the Provincial Civil Defence Co-ordinator in the handling of public relations activities for civil defence orientation courses for hospital personnel, held in Victoria. 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:— (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. 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 (McDougall 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. 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. HOSPITAL INSURANCE SERVICE, 1959 T 31 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, Bam- field. Red Cross Outpost Nursing Station, Blue River. Red Cross Outpost Nursing Station, Edge- wood. Red Cross Outpost Nursing Station, Hudson Hope. Red Cross Outpost Nursing Station, Kyu- quot. 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. T 32 BRITISH COLUMBIA STATISTICAL DATA The tables on the following pages represent statistical data compiled by the Hospital Finance Division. The data deal with the volume of hospital insurance coverage provided to the people of British Columbia through the Hospital Insurance Service. Eighty-seven public hospitals were approved in 1959 to accept B.C.H.I.S. patients. In addition, care was provided in nine outpost hospitals, six Federal hospitals, and eight private hospitals (see page 31). Data for the year 1959 have been estimated from reports submitted by hospitals to November 30th, and are subject to revision when actual figures for the year are submitted. Table I shows that in 1959 the British Columbia Hospital Insurance Service paid public hospitals in British Columbia for 2,267,728 days of care for adults and children, an increase of 97,831 days or 4.5 per cent over 1958. A total of 235,068 B.C.H.I.S. adult and children patients were discharged from British Columbia public hospitals in 1959, an increase of 13,022 or 5.9 per cent over the previous year. This table also shows that 96 per cent of the total patients discharged from British Columbia public hospitals in 1959 were covered by hospital insurance, compared with 91.8 per cent in 1957 and 94.1 per cent in 1958. The increase in the percentage of insured patients, to a large extent, is due to a reduction in residence requirements on July 1st, 1958, from twelve to three months. As is shown in Table IIa, the average length of stay of B.C.H.I.S. adult and children patients in British Columbia public hospitals during 1959 was 9.65 days, a slight decrease from the preceding year. The increase from 1,626 days of care per thousand population in 1957 to 1,724 in 1959, as shown on the notation to Table Ha, is in part due to the inclusion of War Veterans' Allowance patient-days, which were previously paid for by the Federal Government, but under the Federal-Provincial hospital insurance programme are a Provincial responsibility. HOSPITAL INSURANCE SERVICE, 1959 T 33 Table I.—Patients Discharged and Days of Care and Proportion Covered by British Columbia Hospital Insurance Service, 1949-59 Total Hospitalized Covered by B.C.H.I.S. Adults and Children Newborn Total Adults and Children Newborn Total Patients discharged— 1949 1950 1951 1952 1053 164,964 172,645 181,160 188,355 200,893 206,992 216,743 227,359 228,917 236,859 245,881 26,272 26,205 27,096 28,675 30,712 31,984 33,190 35,118 37,376 38,374 38,936 191.236 198,850 208,256 217,030 231,605 238,976 249,933 262,477 266,293 275,233 284,817 140,168 144,959 150,116 154,336 169,167 189,713 199,774 208,293 209,485 222,046 235,068 84.9 84.0 82.9 81.9 84.2 91.7 92.2 91.6 91.5 93.7 95.6 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 2,169,897 2,267,728 85.0 83.6 81.7 81.9 83.9 90.4 91.2 91.2 91.2 93.4 94.5 24,640 23,943 24,172 25,023 27,830 29,483 31,515 33,174 34,963 37,045 38,406 93.8 91.4 89.2 87.3 90.6 92.2 95.0 94.5 93.5 96.5 98.6 200,585 193,307 187,891 184,160 197,100 213,587 212,514 217,252 223,079 232,390 240,756 93.8 90.8 87.7 85.8 89.5 94.5 93.3 93.1 92.6 95.1 96.8 164,808 168,902 174,288 179,359 196,997 1954... 1955 219,196 231,289 1956 241,467 1957 244,448 19581 259,091 273,474 1QSQ2 Percentage of total, patients discharged— 1949 - . 86.2 1950 — - 84.9 1951 ___ 83.7 1952- 82.6 1953 _ -. - — 85.1 1954 91.7 1955 ' 92.5 1956 92.0 1957 91.8 19581 941 19592 - 213,874 212,979 214,285 214,701 220,208 226,031 227,674 233,402 240,872 244,429 248,675 96.0 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 2,322,796 2,399,383 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 2,567,225 2,648,058 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 1957 2,299,415 2,402,287 2,508,484 86 0 19581 _ _ 1959 s 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 1957 _ 91 3 19581 . - . 93 6 19592 94.7 1 Amended as per final reports received from hospitals. 2 Estimated, based on hospital reports to November 30th, 1959. T 34 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, 1949-59. Total Adults and Children Newborn B.C. Public Hospitals Adults and Children Newborn Other B.C. Hospitals Including Federal and Private Adults and Children Newborn Institutions Outside B.C. Adults and Children Newborn Patients discharged- 1949 1950 1951 1952 1953 - 1954... 1955 1956 1957 19581 19592 Patient-days— 1949 1950 _ 1951 — 1952 _ 1953 1954 1955 1956 1957 _ 1958» 1959= Average days of stay- 1949 1950 _ _ 1951 1952 1953 1954 _ 1955 _. 1956 1957 1958» . 1959= 149,280 154,643 159,739 164,379 180,149 199,974 209,999 219,218 221,585 236,770 251,518 ,498,121 ,564,222 ,551,954 ,663,149 ,814,344 ,046,087 ,100,386 ,141,445 ,188,765 ,332,502 ,461,330 10.03 10.11 9.71 10.12 10.07 1,0.23 10.00 9.77 9.88 9.85 9.79 24,989 24,336 24,587 25,492 28,381 29,761 32,035 33,783 35,813 37,924 39,191 203,197 196,333 190,948 187,923 200,738 215,507 215,980 221,022 228,875 238,112 245,906 8.13 8.07 7.76 7.37 7.07 7.24 6.74 6.54 6.39 6.28 6.27 140,168 144,959 150,116 154,336 169,167 189,713 | 199,774 | 208,293 209,485 222,046 235,068 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 2,169,897 2,267,728 10.21 10.19 9.77 10.17 10.13 10.30 10.04 9.80 9.91 9.77 9.65 24,640 23,943 24,172 25,023 27,830 29,483 31,515 33,174 34,963 37,045 38,406 200,585 193,307 | 187,891 I 184,160 197,100 213,587 212,514 217,252 223,079 232,390 240,756 8.14 8.07 7.77 7.36 7.08 7.24 6.74 6.55 6.38 6.27 6.27 7,093 7,617 7,308 7,431 8,173 7,602 8,313 9,473 10,023 12,506 13,800 45,960 65,326 62,771 68,892 75,518 66,960 75,599 79,428 93,980 141,925 167,500 6.48 8.58 8.59 9.27 9.24 8.81 9.09 8.38 9.39 11.35 12.14 151 173 171 161 229 199 361 457 668 665 525 1,146 1,288 1,155 974 1,353 1,251 2,271 2,740 4,299 4,113 3,200 7.59 7.44 6.75 6.05 5.91 6.29 6.29 6.00 6.44 6.19 6.10 2,019 2,067 2,315 2,612 2,809 2,659 1,912 2,050 2,077 2,218 2,650 21,515 22,281 22,081 24,283 25,948 24,304 19,622 20,163 18,449 20,680 26,102 10.66 10.78 9.54 9.29 9.24 9.14 10.26 9.84 8.88 9.45 9.85 198 220 244 308 322 79 159 159 182 214 260 1,466 1,738 1,902 2,789 2,285 669 1.195 1,030 1,497 1,609 1,950 7.40 7.90 7.79 9.06 7.10 8.47 7.52 6.48 8.23 7.51 7.50 1 Amended as per final reports received from hospitals. 2 Estimated, based cn hospital reports to November 30th, 1959. 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; 1959, 1,724. (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, 1959 T 35 Table IIb.—Summary of the Number of B.C.H.I.S. In-patients and Short-stay Patients, 1949-59 Total Adults, Children, and Newborn In-patients Estimated Number of Emergency and Minor-surgery Patients Total Receiving Benefits 1949 174,269 178,979 184,326 189,871 208,530 229,735 242,034 253,001 257,398 274,694 290.709 29,000 44,502 47,656 46,767 52,582 63,621 70,553 76,375 83,530 91,883 100,292 203,269 1950 223,481 1951 231,982 1952 236,638 1953 261,112 1954 _ 1955 _ _ _ 293,356 312,587 1956 1957 _ _ 329,376 340,928 19581 366,577 1959* _ _ 391,001 Totals - _ _ 2,483,546 706,761 3,190,307 [ Amended as per final reports from hospitals. '■ Estimated, based on hospital reports to November 30th, 1959. 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 1959.1 Bed Capacity Total 250 and Over 100 to 249 50 to 99 25 to 49 Under 25 Special Hospitals Patients discharged— Adults and children 235,068 38,406 2,267,728 240,756 9.65 6.27 82,330 11,464 1,011,050 77,756 12.28 6.78 43,295 8,227 388,094 50,871 8.96 6.18 57,216 11,799 478,540 71,635 8.36 6.07 31,444 4,432 239,294 25,959 7.61 5.86 13,085 1,808 96,882 10,760 7.40 5.95 7,698 676 Patient-days— Adults and children 53,868 3,775 7.00 5.58 Average days of stay— Adults and children New-born.- 1 Estimated, based on hospital reports to November 30th, 1959. 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 1959.l Bed Capacity Total 250 and Over 100 to 249 50 to 99 25 to 49 Under 25 Special Hospitals Patients discharged— 100.00 100.00 100.00 100.00 35.02 29.85 44.58 32.30 18.42 21.42 17.11 21.13 24.34 30.72 21.10 29.75 13.38 11.54 10.55 10.78 5.57 4.71 4.27 4.47 3.27 1.76 Patient-days— 2.39 1.57 1 Estimated, based on hospital reports to November 30th, 1959. T 36 BRITISH COLUMBIA < « u a co H 2 ffl __ 60 rt —' 5<S B. ° _J | _ 2 O X ffl O _- <*> H w Z Z U4 ►J CO CO u p4 3 x W Z (-1 J u s? z _J X _; < 1—I H < C-H & o q _j o 0 fc 1 CO z _j u -J o P HI c/1 H 5 -J O 2 <: _. 5 ■_ < w < SOu o (J *3 U O . u (J 2 gg cq Q H <-i CO < Q U O b3 | < HOSPITAL INSURANCE SERVICE, 1959 T 37 CJ Ih _r •_ 00 a_o *£> 1 &M O a"? » w -P< l-l Cm _ _, < 33 o s a. £ OONhNOiin^Triri't If) VO 00 AO VO H t>; CO t^; ^^OOOrrivd'-HCri *-H rt CN rt 00 ON VO m so o ^ c4 d h o\ r- SO <3\ o o o d o 9> s 3)_3c _ _-< Pl,Ph 0>(_00\hNCM--NOiO_ !>Cr;in>nir)OONprtOOcn rt 00 CO O rt \£5 i-H t- rt m «h oo r- m rt cn on I—i O cn c--' ri- cn rf rt d d ^ d S 5 o o B o o < cS U s a ca y CfJ & T3 1> o 3 fl TJ § o o T3 fl U rt OD & fc* o _?J _> ~ ra O ed fl p t/i ; u co <u C T3 E3 in 60 P Ih co ° -3 _?^ ■a S a o 3 S G ca 60 O | id 0 a a T_l ca hi m & tj 4B 5»' & o a. S <0 3 Ch OJ 43 TJ 9 4- TJ 43 O & s a 6 >» >» a co co *- Cfl 54H !_. O T3 O O co g CO rt 3 nj >» >. S P Ih - fl "H O P H <° 3 <D C D O 6 -s ° s. CO " 0J ,-T S3 5 CS CJ u -3 fl o OJ OJ 43 43 P P CO N +3 c. "O c ea _> tH "tJ oj ea 4 £ 1 eN - g CJ 43 "P co oj ca > yi <& yi yi yi co co OJ -H OJ 3 ^ c/_ 2 w .22 6 > O a c C- 00 TJ fl ca CO oj fl O 43 fl o rt T3 c o o TJ 1) TJ J 3 c ca a c o 3 O o 0 y <a s » .3 _i •_?- 3 fl 8 § a •9 ca 'o co oj fl ' OJ co cj o rt 43 On o __! fei P o o « ■•H rt ro 5MQSPOQOOOQ CJ 0) Cfl 41 43 *- E Gf-4 0 O ca Cfl CO H OJ U n (/i co CJ c rt ca (U cu < i p « U ca CJ CO TJ fl »H ca ► fl TJ P fl '3 ca g co" W op • g fl CO •a ta fl Tl .3 >. _ fl CO QJ \% E CJ CJ ° &_ _2 a I cfl o c3 13 S b-S 3 « i_ cj flT3 fl-O a c € ca rv r, rt co P CJ on a o o d o ea O H Mfii-in-MiooOHNmrfiri-Miooi T 38 BRITISH COLUMBIA X H (h p O O oo w £ < . __ ►_ « h ►_ r° gH ^ M S H § o « Q w o « < X u co H z w z o fl< S o O CO < o J3 Oh o Z I CO H Z _ « X £c/> < rt O « « 5 <! H co Z _, « X o g Q Bow M z o n x H (h O -3 n 3 H co w o < H Z « W M u w * >K __] Z w u « W ffl « > SO < •< _J _J 0 1/5 > a w o .d _- •a _• t_ •a a 3 43 CD a o CD a o a, a, < \ -\- \ ^T \ -V S _3 bo CO ft, P P f_ O w o ^s- w HOSPITAL INSURANCE SERVICE, 1959 T 39 e_ § ? goo < O « -J ►2 x ffl H 5! Ph 5 ° (0 00 pi co p, H f_ » n _a w 5 S 2 03 3 CO U r9 co Cj ft Q co o 03 _ ■rt H Z c_ 3 £ b _- H X < co ffl X .-—^ CO _ -J 8 Z 4- 3 co K e < X O ffl p- « UJ i c- o z r* c co O w " S2 5^ ffl _£ 3 u, Q •< 0 __ PH * Z § z 3 o w o D £U Hi ri * Ah g h a o a X ffl <H o 5 o H h| a (H CO z o a o 43 K O Tl H <C _■ P H T3 a fc q a ph H ° CO ^ 3 X! U ■H W c Q ffl o _ c W PI O > 0 5^ 3;. *_" E >< PI P o ffl u ft p) <! F« X ft <1 5b ^ i o < ■\- \ ^rt \ \ \\ "TT —ft __i <;< CO g p Ph 5 n 3 ^ T 40 BRITISH COLUMBIA 15. 56 Neoplasms Circulatory System t%zZ> Congenital sXZZ. Malformations 14.48 Bones 13.05 Blood Infective & 4% Parasitic 12.15 Early c%_ Infancy Provincial Average Average Length of Stay of Patients in Acute-care Hospitals in British Columbia by Major Diagnostic Categories (Excluding New-borns) 1958 ■///a Genito-Urinary M, System 6.30 Deliveries, Pregnancy, Etc. 5.97 Respiratory '//A System 5.79 Symptoms, '//A Senility, Etc. 4.25 '////. Supplementary v/M Classifications HOSPITAL INSURANCE SERVICE, 1959 T 41 oo m OS pj o > Ph pj co < ►J U Ph O PJ Oh « u Ph g ffl T3 < a p- < z I Ph w § I 8 Ph Q P -a > 5 o « r_l to < H Ph CO O < o ffl H Z S H ffl Ph o z o H P a 5 H co ca Ph co_» °} °° °} °° ^ ^ gHI m«Jo\iociH -H.- cnm -h ffl 2 ■§ Mno.HH £ o § o\Oa1n1no _H'3 r-^ d «'r--~ _ Oftn Ph O o w u > pi co < U Hi o __ Ph g ■3 00 h " 3 is 5.2 H ffl ffl H "^ ^PhOhSph o H — CN m ^ct cri ^O T 42 BRITISH COLUMBIA STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR THE FISCAL YEAR ENDED MARCH 31st, 1959 Administration—■ Salaries—Permanent $355,086.93 Temporary assistance 4,131.26 Sub-total, salaries $359,218.19 Office expense 22,310.84 Travelling expense 30,083.02 Office furniture and equipment 2,124.31 Printing and publications 12,780.53 Tabulating and rentals 3,412.93 Motor-vehicles and accessories 129.80 Incidentals and contingencies 632.80 Technical surveys 1,008.14 Payments to hospitals— Claims $37,597,836.51 Vancouver General Hospital re out-patients (Hospital Insurance Act, sec. 35 (30)) 229,678.14 $431,700.57 $37,827,514.65 Less collections, third-party liability 144,133.52 37,683,381.13 Grants in aid of construction and equipment of hospitals 6,114,382.02 $44,229,463.72 Recoveries— Registration fees $1,220.28 Federal share of hospital cost 12,784,038.88 Municipal per diem grants (arrears applicable to 1957/58 not previously taken to account) 214,008.30 12,999,267.46 Total, Hospital Insurance Service $31,230,196.26 Add transfer, Vote 143, re salary revision for Provincial Infirmaries 24,588.00 Total, Vote 346 $31,254,784.26 Certified correct and in accordance with the Public Accounts for the fiscal year ended March 31st, 1959. 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. 1960 510-160-2339
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Eleventh Annual Report British Columbia Hospital Insurance Service JANUARY 1ST TO DECEMBER 31ST 1959 British Columbia. Legislative Assembly [1960]
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Title | Eleventh Annual Report British Columbia Hospital Insurance Service JANUARY 1ST TO DECEMBER 31ST 1959 |
Alternate Title | HOSPITAL INSURANCE SERVICE, 1959 |
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British Columbia. Legislative Assembly |
Publisher | Victoria, BC : Government Printer |
Date Issued | [1960] |
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Legislative proceedings |
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Language | English |
Identifier | J110.L5 S7 1960_V02_12_T1_T42 |
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Sessional Papers of the Province of British Columbia |
Source | Original Format: Legislative Assembly of British Columbia. Library. Sessional Papers of the Province of British Columbia |
Date Available | 2017-09-06 |
Provider | Vancouver : University of British Columbia Library |
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CatalogueRecord | http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1198198 |
DOI | 10.14288/1.0355719 |
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