PROVINCE OF BRITISH COLUMBIA HOSPITAL INSURANCE ACT Twentieth Annual Report British Columbia Hospital Insurance Service JANUARY 1 TO DECEMBER 31 1968 Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1969 Victoria, British Columbia, January 23, 1969. To Colonel the Honourable John R. Nicholson, P.C, O.B.E., Q.C., LL.D., Lieutenant-Governor of the Province of British Columbia. May it please Your Honour: The undersigned has the honour to present the Twentieth Annual Report of the British Columbia Hospital Insurance Service covering the calendar year 1968. RALPH R. LOFFMARK, Minister of Health Services and Hospital Insurance. British Columbia Hospital Insurance Service, Victoria, British Columbia, January 23, 1969. The Honourable Ralph R. Loffmark, Minister of Health Services and Hospital Insurance, Parliament Buildings, Victoria, British Columbia. Sir,—-I have the honour to present herewith the Report of the British Columbia Hospital Insurance Service covering the calendar year 1968. DONALD M. COX, F.A.C.H.A., Deputy Minister of Hospital Insurance. The Honourable Ralph R. Loffmark, Minister of Health Services and Hospital Insurance. Mr. Donald M. Cox, F.A.C.H.A., Deputy Minister of Hospital Insurance. L 05 < z« X u <z 0) tt,tn< o n z o W£Z C 3 ft** < K< 3 .« N ;Ih tu tn Z Q ° < a o u 6 rt 0 u OJ cd ai 3-a c c B es g 0 t U c a rt 01 E 'p. a o t u Q s5 £a = c c o "n o c o B OJ a D. 35 CA o 3 C > ffi 0~1 Q u c rt M U O U «o My pO^-O « u c o.S.5 C 173 fl v: — — <55 c o c o > 03 "5 tf o 3 in T3Q tc o '5 u 3° s-gt 33° Ml "a C o o X o < u r/1 a> O o S5 « 3 O Minister. Deputy Min Assistant D> Director of CONTENTS Page Organization Chart 8 General Introduction 11 20 Years in Review 12 Major Policy Developments, 1949-68 13 British Columbia Regional Hospital Districts Act 14 British Columbia Regional Hospital Districts Financing Authority Act 15 The B.C.H.I.S. Planning Group 15 British Columbia General Hospitals (Comparisons of Growth) 16 The Hospital Insurance Act 18 The Hospital Act 19 Persons Entitled to or Excluded from the Benefits under the Hospital Insurance Act 19 Entitled to Benefits 19 Excluded from Benefits 20 Hospital Benefits Available in British Columbia 20 In-patient Benefits 20 Emergency Services and Minor Surgery 20 Application for Hospital Insurance Benefits 21 The Hospital Rate Board and Methods of Payment to Hospitals 21 Organization and Administration 21 Assistant Deputy Minister 22 Hospital Finance Division 22 Hospital Accounting 23 Hospital Claims 24 Hospital Construction and Planning Division 27 Hospital Projects Completed during 1968 28 Hospital Projects under Construction at Year-end 32 Projects in Advanced Stages of Planning 32 Additional Projects Approved and in Various Planning Stages 33 Director of Hospital Consultation, Development, and Research 34 Hospital Consultation and Inspection Division 34 Research Division 36 Medical Consultation Division 37 Administrative Officer 39 Eligibility Representatives' Section 40 Third Party Liability Section 40 General Office 40 Public Information 41 9 2 M 10 BRITISH COLUMBIA Page Approved Hospitals 42 Public Hospitals 42 Outpost Hospitals 43 Federal Hospitals 43 Private Hospitals (Providing General Hospital Services) 43 Rehabilitation, Chronic, and Convalescent Hospitals 43 Extended Care Hospitals 43 Statistical Data. 43 Table 1a.—Patients Separated (Discharged or Died) and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public Hospitals Only, 1949-68 (Excluding Federal, Private, and Out-of-Province Hospitalization) (Including Rehabilitation Hospitals) 45 Table 1b.—Total Patient-days and Proportion Covered by the British Columbia Hospital Insurance Service, British Columbia Public Hospitals Only, 1949-68 (Excluding Federal, Private, and Out-of-Province Hospitalization) (Including Rehabilitation Hospitals) 46 Table 2a.—Patients Separated, Total Days' Stay, and Average Length of Stay According to Type and Location of Hospital for B.C.H.I.S. Patients Only, and Days of Care per Thousand of Covered Population, 1949-68 (Including Rehabilitation Hospitals) 47 Table 2b.—Summary of the Number of B.C.H.I.S. In-patients (Including Rehabilitation Patients) and Short-stay Patients, 1949-68 48 Table 3.—Patients Separated, 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 1968 (Excluding Extended Care Hospitals) 48 Table 4.—Percentage Distribution of Patients Separated and Patient-days for B.C.H.I.S. Patients Only, in British Columbia Public Hospitals, Grouped According to Bed Capacity, Year 1968 (Excluding Extended Care Hospitals) 49 Charts 49 I.—Percentage Distribution of Days of Care by Major Diagnostic Groups, 1967 50 II.—Percentage Age Distribution of Male and Female Hospital Cases and Days of Care, 1967 51 III.—Percentage Distribution of Hospital Cases by Type of Clinical Service, 1967 52 IV.—Percentage Distribution of Hospital Days by Type of Clinical Service, 1967 53 V.—Average Length of Stay of Cases in Hospitals in British Columbia by Major Diagnostic Groups, 1967 (Excluding Newborns) 54 Hospitalization by Major Diagnostic Categories, 1967 55 Statement of Receipts and Disbursements for the Fiscal Year Ended March 31, 1968 59 Twentieth Annual Report of the British Columbia Hospital Insurance Service GENERAL INTRODUCTION Donald M. Cox, F.A.C.H.A., Deputy Minister of Hospital Insurance January 1, 1969, will mark a significant date in the development of one of British Columbia's most successful programmes of social service, as it will represent the 20th anniversary of the British Columbia Hospital Insurance Service. The article " 20 Years in Review," which follows these introductory comments, outlines briefly the development of the Service. The tremendous programme of hospital construction which has been under way throughout the length and breadth of the Province for many years (see photographs on pages 30 and 31) continued through 1968 without let-up. Major projects completed in 1968 involved a total of 660 new beds, of which 282 were for extended hospital care accommodation, as well as the improvement and expansion of diagnostic and treatment services. Included in those communities which saw the completion of hospital construction and renovation programmes in 1968 were White Rock, Cranbrook, Fort St. John, Campbell River, Grand Forks, Murrayville, Powell River, Richmond, Enderby, Vernon, Comox, Pouce Coupe, Prince George, Vancouver, and Victoria. In addition to these completed projects, hospital construction programmes were under way at the year-end in the following centres: Quesnel, Abbotsford, Castlegar, Creston, Kelowna, Port Alberni, Revelstoke, Terrace, Surrey, New Westminster, Trail, and Vancouver. Provincial Government approvals-in-principle and approvals to plan had been given to the boards of management of over 45 hospitals. The regional hospital district programme, introduced by the Provincial Government in 1967 through enactment of the Regional Hospital Districts Act and the Regional Hospital Districts Financing Authority Act, has met with a great deal of success. During 1968 five regional hospital districts were incorporated, making a total of 28 regional hospital districts throughout British Columbia. Payments to hospitals have continued to increase each year, and in the 1968/69 fiscal year an estimated $137,000,000 will be paid by the British Columbia Hospital Insurance Service to the hospitals of the Province toward expenses incurred by residents. In February, 1968, day-care surgical services for out-patients were provided as an extension of the coverage offered through the Hospital Insurance Service. Medical advances in recent years, particularly in the field of anaesthesia, have made it possible for a number of surgical procedures to be carried out without requiring the patient to be admitted as an in-patient. The provision of this additional benefit, for which the beneficiary is required to pay only $2, has proven to be extremely satisfactory. Based on the assumption that day-care surgical-service patients would usually be in hospital for two days had they been admitted as in-patients, a total of 23,000 patient-days would have been utilized in the 10 months that the new benefits have been in use. In other words, the introduction of these services has saved the equivalent of 95 to 100 in-patient beds, based on 80 per cent occupancy. 11 M 12 BRITISH COLUMBIA In December, 1968, benefits were extended to include, on an out-patient basis, those patients attending psychiatric clinics in British Columbia hospitals to be designated by the Minister of Health Services and Hospital Insurance. The patient would be required to pay $1 a day for the services. This extension of coverage is expected to free more hospital beds in psychiatric units for acutely ill in-patients by allowing those who still require care to be discharged earlier than was previously possible. I should like to once again express our appreciation for the advice and guidance extended the Hospital Insurance Service by members of the medical profession. We are very appreciative of the assistance rendered by the College of Physicians and Surgeons and by the Canadian Medical Association (British Columbia Division). The laboratory and radiological advisory councils continued to be of inestimable value in assisting hospitals to improve the laboratory and radiological services, and in advising the Service regarding the approval of Provincial grants-in-aid for the purchase of major hospital equipment. The British Columbia Hospitals Association continued to render very valuable advice to the Service. The liaison committee with the association, inaugurated in 1966, has been an effective channel of communication between the Service and the association, and the resulting improvements in co-operation have made the committee a very worth-while development. In December our Branch was honoured by the Prime Minister when he presented us with a silver-on-gold safety award from the British Columbia Safety Council for 792,217 accident-free man-hours of operation. Reports submitted by the various divisions which comprise the administrative structure of our Branch appear under " Organization and Administration," commencing on page 21. 20 YEARS IN REVIEW On December 31, 1968, the British Columbia Hospital Insurance Service completed its 20th year of operation. British Columbia's programme of insured hospital coverage had four main objectives when the plan came into being on January 1, 1949: first, to protect the residents of the Province against the financial burden associated with hospitalization; second, to provide the hospitals of the Province with a regular source of income; third, to assist hospitals in developing and maintaining high standards of patient-care; and, finally, to assist communities in providing adequate hospital facilities. During the 20 years since the commencement of the programme, continuous and vital progress has taken place in the provision of expanded facilities and improved hospital services throughout the Province. This progress in the hospital field was brought about through the combined efforts of government, hospitals, professional and community organizations, and individuals whose contributions have ensured that the residents of British Columbia have efficient hospital services at their disposal. It is of interest to note that from January 1, 1949, to December 31, 1968, approximately 1 billion 4V2 million dollars has been paid by the Provincial Government, through the British Columbia Hospital Insurance Service, to the hospitals of the Province toward hospital expenses incurred by residents. This represents the sum of about $500 for each man, woman, and child living in British Columbia at the present time. While the average hospital bill paid by the Hospital Insurance Service is now approximately $350, individual bills have exceeded $25,000 when an urgent medical need for active treatment care was required over a period of many months. In addition to the financial assistance provided to residents incurring hospital care, the Provincial Government has also provided grants of over $68,000,000 toward the construction costs of major hospital projects, and an estimated $20,000,000 toward the purchase of hospital equipment HOSPITAL INSURANCE SERVICE, 1968 M 13 and furnishings. British Columbia's accelerated programme of hospital construction has produced over 9,000 beds, in addition to new diagnostic and treatment areas, emergency departments, laboratory facilities, laundry buildings, and schools of nursing. These expenditures represent a total payment to British Columbia hospitals of over 1 billion 92 million dollars during the 20 years of hospital insurance coverage. The value of the hospital insurance programme as measured in dollars represents only one yardstick of accomplishment, and although the protection of residents of the Province from the crippling cost of hospital bills and the provision of financial assistance in the development of adequate facilities are most important, they are no more vital than the progress made in improved standards of patient-care. These improvements may be illustrated by studying the advances made in the quality and quantity of services provided by the Province's general hospitals. Prior to hospital insurance, many hospitals were unable to provide their patients with adequate services, primarily because of the tremendous cost of equipping departments and employing professional personnel. Through the combined efforts of hospitals and professional organizations, together with the financial and advisory services offered by the Provincial Government, the quality of hospital care in British Columbia has been progressively improved over the years. It is significant to note that during the past 20 years the total gross expenditure by public general hospitals in British Columbia has increased from $16,000,000 to $134,000,000. During the same period total numbers of staff employed in hospitals have increased 191 per cent to 18,900, total patient-days by 110 per cent to 3,100,000, and the Province's population by 84 per cent to approximately 2,000,000. Changing concepts in medical care brought about the need for additional provisions within the framework of the British Columbia plan and, as a result, rehabilitation and activation care benefits were introduced in September, 1960, and extended hospital care in December, 1965. Further evidence of the Province's willingness to provide its residents with all-inclusive coverage was the introduction of out-patient cancer therapy benefits available at facilities in Vancouver and Victoria in 1967, and the provision of day-care surgical services in February, 1968, and out-patient psychiatric services in designated hospitals in December, 1968. With increasing activity throughout the Province in connection with the planning of hospital expansion and renovation programmes, and with continuing vigilance on the part of hospital administration, medical and nursing staffs, it is apparent that the residents of British Columbia will continue to enjoy high standards of hospital care for many years to come. Major Policy Developments, 1949-1968 Premium Payment Plan, 1949-1954 From January 1, 1949, to March 31, 1954, the major portion of revenue for the Hospital Insurance Service was derived from compulsory premium payment. During the first year, annual premiums were levied on the basis of $15 for a single person, $24 for a person with one dependent, and $30 for a person with two or more dependents. Premiums were remitted through monthly payroll deduction or by direct payments, levied twice a year. At one time over 5,000 firms were registered for monthly payroll deductions. It became apparent that the premium method of providing funds for the hospital insurance programme was not satisfactory, due in part to the fact that some 20 per cent of the Province's labour force changed employment frequently or was seasonally employed. There was a marked resistance to compulsory registration requirements M 14 BRITISH COLUMBIA for insurance coverage from many people who were self-employed. At the time the premium plan terminated in March, 1954, annual premiums were $27 for a single person and $39 for a head of family. One Year's Residence for Coverage, 1954-1958 Effective April 1, 1954, the collection of premiums was discontinued. Entitlement to hospital insurance benefits became contingent upon the completion of 12 months' permanent residency in British Columbia. The operation of the Hospital Insurance Service is financed from funds voted annually by the Legislature. Federal-Provincial Plan, luly 1,1958 July 1, 1958, marked the start of the Federal-Provincial hospital insurance plan, and British Columbia was among the first of the Provinces to become a participating member as of that date. Under this programme each Province is responsible for the development, administration, and operation of its own hospital insurance plan. Provided the Province meets the minimum requirements set forth in the Federal Act and regulations, the Federal Government shares certain stipulated costs. The cost- sharing formula for Federal payments is on the basis of 25 per cent of the Provincial per capita cost plus 25 per cent of the Canadian per capita cost for hospital care. With the introduction of the Federal-Provincial plan, the length of permanent residency required to establish entitlement to coverage was reduced from the existing 12 months to three consecutive months. Through reciprocal arrangements with other Provinces, three months' out-of-Province benefits plus reasonable travel time are provided to residents moving within Canada. Rehabilitation and Activation Care, September 1, 1960 On this date British Columbia expanded its programme to include rehabilitation in approved hospitals. In-patient care is provided to patients who no longer require the intensive diagnostic and treatment services of an acute-care hospital, and who, in the opinion of medical authorities, will benefit from rehabilitation treatment services to the extent that they may return to their homes. Extended Hospital Care, December 1, 1965 A further expansion of the British Columbia plan extended benefits to those patients in approved facilities operated by public hospitals or other non-profit agencies for whom skilled nursing care on a 24-hour-a-day basis and continuing medical supervision is shown to be required. Regional Hospital Districts, March, 1967 The Provincial Legislature, in March, 1967, made provision for the division of the Province into 29 large districts to enable regional planning, development, and financing of hospital projects to be carried out under a revised formula which increased the financial assistance provided by the Provincial Government toward capital costs (see " British Columbia Regional Hospital Districts Act " below). BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS ACT The Act provides for the division of the Province into large districts to enable regional planning, development, and financing of hospital projects to be carried out under a revised formula, which provides increased financial assistance from the Provincial Government toward the capital cost of hospital projects. The Province was divided into 29 areas, and 28 of them had been incorporated as regional hospital districts by the end of 1968. HOSPITAL INSURANCE SERVICE, 1968 M 15 As is the case with school construction, each regional hospital district will, subject to the requirements of the Act, be able to pass money by-laws authorizing debentures to be issued covering the total cost of one or more hospital projects. When approval has been obtained from the Minister of Health Services and Hospital Insurance, the district will be able to raise any funds immediately required by temporary bank borrowing on a uniform basis. The Regional Hospital Districts Financing Authority (see below) will in due course issue and sell its own debentures in the amount required, which may cover a number of district debenture issues. At that time the districts will then be able to sell then debentures to the Authority. Following this a district can repay any sum which has been temporarily borrowed. Each year the Provincial Government will pay through the Hospital Insurance Service its share of the amortization cost in accordance with section 22 of the Act. Each district will in turn raise, by taxation, the remainder of the annual amortization cost required to retire its debentures which are held by the Authority. Under the new formula the Province pays annually to each district 60 per cent of the net cost of amortizing the district's borrowings for an approved hospital project, after deduction of Federal Government capital grants and items which are the district's responsibility, such as provision of working funds for hospital operation, etc. If a 4-mill tax levy by the district is inadequate to discharge its responsibility in regard to annual charges on old debt for hospital projects, as well as the remaining 40 per cent of the charges on the new debt resulting from a hospital project, the Province will provide 80 per cent of the funds required in excess of the 4-mill levy. The affairs of each regional hospital district are managed by a board comprised of the same representatives of the municipalities and unorganized areas who comprise the board of the regional district (incorporated under the Municipal Act), which will have the same boundaries as the regional hospital district. The board of the regional hospital district will be responsible for co-ordinating the requests for funds from hospitals within the district, and for presenting money by-laws to the taxpayers in respect of either single projects or an over-all programme of hospital projects for the district. A hospital society or corporation is not compelled to seek financing under this new Act. In situations where the community's share of the cost can be, or has already been, raised by other means, a Provincial Government grant under the old 50-per-cent formula can be applied for under the procedure which was applicable up to this time. BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS FINANCING AUTHORITY ACT This Act establishes a Provincial Government authority similar to the one set up a few years ago to assist school districts in financing their projects. The functions of the Authority are referred to briefly in the second paragraph of the preceding commentary regarding the Regional Hospital Districts Act. B.C.H.I.S. PLANNING GROUP This group was formed in December, 1965, to co-ordinate and expedite the planning for hospital facilities. The Planning Group's functions are to review research reports on hospital bed needs, study submissions from hospitals for increases in beds or services, consider other problems related to the orderly planning and provision of facilities and services to meet the needs of the Province, and to consider other matters referred to it by the Deputy Minister. The Planning Group is responsible for making recommendations on these matters to the Deputy Minister. (Continued on page 18.) M 16 BRITISH COLUMBIA British Columbia General Hospitals Comparison of Growth B.C.H.I.S. Payments to Hospitals for In-patient Care {Including Federal and Contract Hospitals) 1966 1967 1968 (Est.) Total Full-time Staff and Average Number of Patients (Adults and Children) per Day 15 14 13 c I ,1 c H 10 9 8 7 6 5 fc*^ ,v^VV .■f^ ^r ttf^*- p.-i oV PATIS^ Va & ° pE ^&^^Z ,y~-~" 15 14 13 12 -1 o 1966 1967 1968 (Est.) HOSPITAL INSURANCE SERVICE, 1968 Gross Salaries and Wages and Other Operating Expenses M 17 r«s &p\^> **#**%. £t4SV.= ^*^* .OtW^j . 1966 1967 1968 (Est.) ♦Including approximately $4,000,000 in staff fringe benefits Hospitals' Growth Rate (Public General Hospitals, Excluding Federal and Contract Hospitals, Etc.) 1948 1968 (Est.) Per Cent Increase Total gross expenditure (excluding depreciation). Staff (full-time equivalent).. Total patient-days (adult and child).. Population of British Columbia... $16,081,000 6,500 1,476,000 1,082,000 $134,000,000 18,900 3,100,000 1,994,000 800 191 110 84 M 18 BRITISH COLUMBIA The regular members are as follows: Director, Hospital Consultation, Development, and Research (Chairman); Assistant Deputy Minister (Vice-Chairman); Medical Consultant; Manager, Hospital Construction and Planning Division; Director, Research Division; Manager, Hospital Consultation and Inspection Division. The Planning Group held 30 meetings during the year. Some of these were meetings with hospitals or other agencies, such as the Hospitals Committee of the British Columbia Medical Association and the Regional Medical Director and staff from the Pacific Region, Department of National Health and Welfare. Individual members on the Planning Group have acted as liaison members between the Service and several local hospital planning groups. During the year two sub-committees were set up under the Planning Group to undertake specific tasks. The first of these was to develop a design programme for extended care hospitals. Drafts of this programme had been completed at the year-end and were reviewed with a committee of the Architectural Institute of British Columbia. The object of the programme is to speed the planning of extended care units, with particular emphasis at the start on the larger units required for metropolitan areas. The second sub-committee was appointed to examine the feasibility of new types of facility for provision of health services in smaller communities. After these studies have been completed, the sub-committee will add a second function: that of examining and recommending on the way in which certain services can best be distributed in a region. Action was taken on four new reports by the Research Division involving eight hospitals. Teams from Planning Group visited three of the four regional districts to discuss the projections and planning problems. In addition to the new reports, several previous reports were brought up to date and reviewed. The Victoria district hospital study prepared by outside consultants was analysed. In connection with the above reviews, approval was given for preliminary planning of over 750 beds, the majority of these being for extended hospital care. These approvals for planning were in addition to those outstanding in the previous year. Apart from the activities previously mentioned, the group concerned itself with other planning matters; for example, an examination with the Mental Health Branch of the integration of mental health facilities with general hospitals. THE HOSPITAL INSURANCE ACT This is the Statute which authorizes British Columbia's hospital insurance plan, and under which the British Columbia Hospital Insurance Service is established. The main provisions of this Act and the regulations may be summarized as follows:— (1) Generally speaking, every permanent resident who has made his home in British Columbia for at least three consecutive months is entitled to benefits under the Act. (2) Approved hospitals are paid an all-inclusive per diem rate for medically necessary in-patient care rendered to qualified British Columbia residents who are suffering from an acute illness or injury, and those who require active convalescent rehabilitative and extended hospital care. The payment made to a hospital by the British Columbia Hospital Insurance Service amounts to $1 less than the per diem rate approved for the particular hospital, and the patient is responsible for paying the remaining dollar. The Provincial Government pays the dollar-a-day charge on behalf of Provincial social welfare recipients. HOSPITAL INSURANCE SERVICE, 1968 M 19 (3) The wide range of in-patient benefits, together with the emergency outpatient, minor surgery, and day-care surgical services, provided under the Act are described on the following pages. (4) Qualified persons who are temporarily absent from British Columbia are entitled to certain benefits for a period of six months if they are admitted to an approved hospital within the first six months following their departure from the Province. These periods may be extended for an additional period of up to six months by the Lieutenant-Governor in Council. THE HOSPITAL ACT One of the important functions of the British Columbia Hospital Insurance Service is the administration of the Hospital Act. The Deputy Minister of Hospital Insurance is also the Chief Inspector of Hospitals for British Columbia under the Statute. The Hospital Act controls the organization and operation of hospitals, which are classified as follows:— (1) Public hospitals—non-profit hospitals caring primarily for acutely ill persons. (2) Private hospitals. This category includes (a) small public hospitals, most of which are operated in remote areas by industrial concerns primarily for their employees, and (b) licensed nursing homes which are not under B.C.H.I.S. coverage. (3) Rehabilitation, chronic, and convalescent hospitals. These are non-profit hospitals approved under Part III of the Hospital Act, primarily for the treatment of persons who will benefit from intensive rehabilitative and extended hospital care. PERSONS ENTITLED TO OR EXCLUDED FROM THE BENEFITS UNDER THE HOSPITAL INSURANCE ACT Entitled to Benefits A person is entitled to benefits if he qualifies as a beneficiary under the Hospital Insurance Act. Generally speaking, a person is a beneficiary if the provision of hospital care is a medical necessity, and if he establishes that he qualifies under one of the following categories:— (a) He is the head of a family, or a single person, who has made his home in the Province and has lived continuously therein during the preceding three consecutive months; or (b) Having qualified under item (a), he leaves the Province temporarily and returns after an absence of less than 12 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 brief period without incurring 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. M 20 BRITISH COLUMBIA Excluded from Benefits Some of the main classes of persons either permanently or temporarily excluded from benefits are as follows:— (a) A person who works full or part time in British Columbia but who resides outside the Province; or (b) A qualified person who leaves British Columbia temporarily and fails to return and re-establish residence within 12 months; or (c) A qualified person who leaves British Columbia and who establishes residence elsewhere; or (d) An inmate of a Federal penitentiary; 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 (f) Persons entitled to receive hospital treatment under the Statutes of Canada or any other government; for example, members of the Armed Forces or Royal Canadian Mounted Police, and consular officials of other countries. HOSPITAL BENEFITS AVAILABLE IN BRITISH COLUMBIA In-Patient Benefits In addition to standard-ward accommodation with meals and necessary 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 a few 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. Other approved services rendered by employees of the hospital. (Note.—Private or semi-private rooms cost more to maintain than standard wards, and the patient is required to pay extra for such accommodation if it is requested by or on behalf of the patient.) Emergency Services, Minor Surgery, and Day-care Surgical Services The following services and treatments are also provided in British Columbia public hospitals to beneficiaries who do not require in-patient care:— Emergency treatment within 24 hours of being accidentally injured. Operating-room or emergency-room services for minor surgery, including application and removal of casts. Day-care surgical services are available to patients who require operating-room or other specialized treatment facilities, but who would be discharged within 24 hours. A beneficiary is required to pay $2 for each visit to the hospital for the services, etc., it has provided, and the remainder of the cost is paid by the British Columbia Hospital Insurance Service. However, if the patient received treatment from a physician while at the hospital, he is responsible for paying the doctor, as such charges are not payable by the British Columbia Hospital Insurance Service. Non-beneficiaries are required to pay the full charge for the hospital services and treatment received. HOSPITAL INSURANCE SERVICE, 1968 M 21 APPLICATION FOR HOSPITAL INSURANCE BENEFITS At the time of admission to hospital, a patient wishing to apply for coverage under the hospital insurance programme is required to make an Application for Benefits. The hospital is responsible for verifying the patient's statements regarding length of residence, etc., to determine if the patient is a qualified resident as defined in the Hospital Insurance Act and regulations. Payment is then requested by the hospital from the British Columbia Hospital Insurance Service, which may reject any account where either the patients status as a qualified resident or the medical necessity for his receiving hospital care benefits has not been satisfactorily established. (See Eligibility Section.) THE HOSPITAL RATE BOARD AND METHODS OF PAYMENT TO HOSPITAL The Hospital Rate Board, appointed by Order in Council, is composed of the Assistant Deputy Minister of Hospital Insurance (Chairman); the Director of Hospital Consultation, Development, and Research (Vice-Chairman); the Hospital Finance Manager; and the Hospital Consultation and Inspection Manager. The purpose of the Board is to advise the Deputy Minister in regard to the rates of payments to hospitals. A system of firm budgets for hospitals, which has been in use since January 1, 1951, provides for a review of hospitals' estimates by the Rate Board. 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 established. 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. Approximately 96 per cent of all hospital accounts incurred in British Columbia are the responsibility of the British Columbia Hospital Insurance Service. Cash advances to hospitals are made on a semi-monthly basis, so that hospitals are not required to wait for payment until patients' accounts are submitted and processed by the British Columbia Hospital Insurance Service. Qualified patients are charged $1 per day, which is deductible when calculating payments to hospitals from the Service. Non-qualifying residents are charged the hospitals' established per diem rates, which are all-inclusive; that is, the daily rate covers the cost of all the regular hospital services, such as X-ray, laboratory, operating-room, etc., provided to patients, in addition to bed, board, and nursing care. ORGANIZATION AND ADMINISTRATION The British Columbia Hospital Insurance Service is a branch of the Department of Health Services and Hospital Insurance, the other branches being Health, and Mental Health Services. The administrative head of the Hospital Insurance Service is Mr. Donald M. Cox, F.A.C.H.A., Deputy Minister of Hospital Insurance. M 22 BRITISH COLUMBIA The following reports provide a brief outline of the work carried out during 1968 by the various divisions and offices which comprise the administrative structure of this branch. Assistant Deputy Minister W. J. Lyle, F.C.I.S. The Assistant Deputy Minister is responsible for the operation of the Hospital Finance Division and the Hospital Construction and Planning Division, and for the administration of the Service in the absence of the Deputy Minister. He is Chairman of the Hospital Rate Board (see page 21), Chairman of the Special Services Committee, Vice-Chairman of the B.C.H.I.S. Planning Group (see page 15), and a member of the following committees: Advisory Committee on Hospital Insurance and Diagnostic Services (a committee appointed by the Federal Government to advise on the administration of the Hospital Insurance and Diagnostic Services Act), the Sub-committee on Finance, the Radiological Advisory Council, and the British Columbia Hospitals' Association Liaison Committee. A summary of the activities of the two Divisions for which the Assistant Deputy Minister is responsible follows. Hospital Finance Division N. S. Wallace, C.G.A., Manager Hospital accounting and the payment of hospital claims are the two main functions of the Hospital Finance Division. At the 1967 Session of the Legislature, two Acts were passed which changed the method of financing hospital capital projects—the Regional Hospital Districts Act and the British Columbia Regional Hospital Districts Financing Authority Act. The Finance Division is responsible for reviewing the annual budgets prepared by each regional hospital district as required by the legislation, and works closely with the Hospital Financing Authority and the regional hospital districts in the financing of hospital capital projects and repayment of debentures. During 1968 the Finance Division assisted the regional hospital districts in debenture sales to the British Columbia Regional Hospital Districts Financing Authority amounting to $19,936,- 000 and provided capital grants of approximately $575,000 toward the repayment of principal and interest on capital borrowings of the regional hospital districts. The Finance Division is also responsible for the approval of grants to assist hospitals in the purchase of equipment. In 1968, after a review of approximately 5,000 applications received from hospitals, grants of approximately $1,800,000 were approved on movable and fixed technical equipment costing $5,500,000. As a means of assisting hospital employees to maintain high working standards, the Hospital Insurance Service provided over $100,000 during the year to enable hospital employees to attend or participate in short-term training programmes. This is additional to the long-term educational training courses sponsored for certain hospital employees through Federal assistance. Close liaison was continued with the Commissioner of Municipal Superannuation in respect to the application of the Act to hospital personnel, and the postponement of retirement for certain employees who reach maximum retirement age. The Division Manager continued to perform duties as a member and Secretary of the Hospital Rate Board and as a member of the Sub-committee on Hospital Finance and Accounting (a sub-committee appointed by the Federal Government to advise on the administration of the Hospital Insurance and Diagnostic Services Act). HOSPITAL INSURANCE SERVICE, 1968 M 23 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 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 board is 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. Hospital Accounting H. G. Benjamin, C.G.A., Supervisor The work of the Hospital Accounting Section falls into three main categories: (a) the detailed inspection, in the field, of the financial records of the hospital for purposes of verification of annual and other financial statements; (b) the assembly of relevant information and preparation of tabulations and other data, for the use of the Hospital Rate Board in its review of the hospital's annual operating and pre- construction estimates; and (c) the assembly of information and preparation of data for the Deputy Minister in the review of the annual budgets of regional hospital districts. Work in category (c) is a result of the passage of the Regional Hospital Districts Act at the 1967 sitting of the Legislature. In carrying out the inspection duties in 1968, visits were made at least once to each of 101 public general, rehabilitation, and extended care hospitals. The gross expenditures approved by the Hospital Rate Board for public general, rehabilitation, and extended care hospitals for the year 1968 amounted to $131,000,000. Other functions performed by the Hospital Accounting staff include: — (a) The tabulation of monthly statistical and financial reports from hospitals, and the correlating of these with the approved budgets. (b) The calculation 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 provision, on request, of accounting assistance and instruction to smaller public hospitals in the Province. (e) The carrying-out of accounting reviews and cost studies of nursing homes, upon the request of the Social Welfare Department, for welfare payment purposes. (/) The auditing of accounts of hospital construction projects, to determine the amount of construction grants payable by the Province. M 24 BRITISH COLUMBIA The Annual Report on Hospital Statistics, issued by the Department of Health Services and Hospital Insurance and covering the administration of the Hospital Act for the preceding year, is prepared by this office. During 1968, construction projects involving expenditure of $2,430,000 were audited and the required statements prepared for the Federal Government, in order that Federal construction grants could be claimed on behalf of the hospitals. During the year a number of experienced accounting inspectors left the Service, and difficulties were encountered in obtaining suitable replacements, resulting in a delay in the audit of construction projects and annual inspectional visits to hospitals. Hospital Claims Section W. J. Wade, Supervisor The staff of Hospital Claims is responsible for processing the Admission- Separation Records (accounts), which hospitals submit for each patient, and approving for payment all acceptable claims. Assistance is provided to hospitals by the Section in the proper method of submitting the individual accounts. This is accomplished by correspondence, telephone, and personal visits. During the year the supervisor visited hospitals in the Vancouver Island and Lower Mainland areas. Day-care surgical service procedures, inaugurated in February, 1968, required a new set of forms and procedures. These were planned in close consultation with the Medical Consultant's staff and the Director of Research. The information obtained on the new form is transferred to a statistical I.B.M. card for eventual processing by the Data Processing Centre. These accounts were in excess of 11,000 for the period of March 1 to December 31, 1968. The filing, accounting, and review of the quarterly billing for extended care hospital patients continued to increase in volume as new units were added to hospitals or new hospitals added to the programme. The number of different procedures required also increased because of changes to the welfare regulations regarding extended-care patients, and the change in registering all welfare recipients with the British Columbia Medical Plan. Research and adjustments to accounts, due primarily to changes of responsibility, showed an increase in volume. Accounts processed were in excess of 1,600 per working-day for in-patients, and over 800 emergency-service or minor-surgery account forms were handled per working-day. Discussions with the Data Processing Centre were held regarding the efficient use of the I.B.M. electronic data-processing equipment. These included discussions on the designing of the key-punch card in relation to the day-care surgical accounts, out-of-Province accounts, and special surveys. A brief outline of the work and duties performed by the various offices of the Hospital Claims Section follows. The staff of Admission Control reviews each application for benefits made by patients who claim to be qualified for benefits under the Hospital Insurance Act. Details of residence are checked with the verifying documents; during the year over 7,200 had to be returned to hospitals because they were incomplete or unacceptable. Advice and assistance were given to hospital admitting staffs on the proper method of obtaining and recording the patient's residence information and employment history. In order to further assist in the co-operation between the British Columbia Hospital Insurance Service and hospitals, the supervisor of Admission Control visited hospitals in the Lower Mainland area and on Vancouver Island for discussions of the procedures being used for verification of the residence of patients. HOSPITAL INSURANCE SERVICE, 1968 M 25 The Accounts Payment staff pre-audits the charges made to the British Columbia Hospital Insurance Service, and ensures that all information shown on each claim is completed so that it can be coded for statistical purposes, and that it is charged to the correct agency, such as to the British Columbia Hospital Insurance Service, Workmen's Compensation Board, the Department of Veterans Affairs, or other Provinces and Territories. During the year over 650 queries per month on such accounting matters were addressed to British Columbia hospitals. Preliminary figures for 1968 show that more than 390,000 accounts (excluding out-of-Province) were processed. For comparison the figures for 1967 were 382,157 processed. The staff of Social Welfare Records continued to maintain the alphabetical file of all health services identification cards issued to welfare recipients in this Province. Over 38,000 hospital accounts incurred by welfare recipients were checked to this file to determine eligibility for hospital benefits. The new procedures which followed the Department of Social Welfare changes necessitated extra work in locating cards which were recorded differently subsequent to November 1st while a change-over period existed from July 1st to November 1st. The new system required a new file to accommodate some 65,000 forms, with changes being received daily from welfare offices in British Columbia. The Voucher and Key-punch staff are responsible for batching and vouchering the checked accounts, in order to determine the amounts payable to each hospital and for the punching of an I.B.M. card for each account. The cards are punched daily to record statistical, financial, and medical data, and are used to tabulate remittance listings of payments due to hospitals and for morbidity statistics for the Research Division. New procedures included the new out-of-Province account cards and the day-care surgical services account cards. The Out-of-Province personnel process all claims for hospital accounts incurred by British Columbia residents in hospitals outside the Province. This includes establishing eligibility and the payment of claims. During 1968 over 4,400 accounts, amounting to an estimated $1,000,000, were paid on behalf of qualified residents who were hospitalized in the other Provinces and Territories of Canada, and the continental United States, including Alaska and Hawaii; Austria, Australia, Belgium, British Honduras, British West Indies, England, France, Grand Canary Islands, Greece, Holland, Hong Kong, Hungary, Iran, Israel, Italy, Japan, Mexico, New Zealand, Norway, Phillipines, Portugal, Scotland, South America, Spain, Sweden, Switzerland, Tahiti, Trinidad, and West Germany. Correspondence to accomplish the procedures amounted to over 17,000 letters for the year. This office also compiles up-to-date hospital rate schedules for every approved hospital in Canada. Commencing January 1, 1968, all accounts were coded for statistical purposes and an I.B.M. card punched for each account. The Filing and Mail Unit sorted and filed over 5,500 documents and letters daily, an increase of 500 over last year. The filing system was expanded and new procedures instituted, in order to accommodate the increase. A survey was completed in order to assess the possibility of installing open-shelf files to replace the older cabinet files. M 26 BRITISH COLUMBIA Many factors contribute to increasing hospital costs. These include the need for complex diagnostic and operating-room equipment, specialized dietetics, and professional personnel on 24-hour duty. This is a photograph of the biochemistry laboratory in the new diagnostic laboratory building at St. Paul's Hospital, Vancouver (1962). 4 3 Adequate provision for psychiatric care in general hospitals is part of the modern patient-care concept. This is the patients' lounging area, overlooking an enclosed landscaped patio, in the Bay Pavilion of the Royal Jubilee Hospital, Victoria. In addition to the new hospitals constructed during the past 20 years (see pages 30 and 31), several major projects not involving patient beds have also been built. These have included new diagnostic and treatment areas, laboratories, emergency departments, laundry buildings, and nurses' residences and training-schools. Modern lecture facilities are an important feature of the new 195- bed nurses' residence and training- school at the Royal Columbian Hospital, opened in May, 1962. It is one of six nurses' training- schools in British Columbia. HOSPITAL INSURANCE SERVICE, 1968 M 27 Hospital Construction and Planning Division The primary responsibilities of this Division may be summarized as follows:— (1) Working with hospital boards of management and hospital construction and planning committees in the development of programmes for the construction of new hospital facilities, and additions to and renovations of existing hospitals. (2) Providing consultative services to hospitals planning projects and recommending such programmes for approval. (3) Processing and recommending for approval applications for Provincial grant assistance toward capital improvement and renovation projects. The Division also initiates applications for Federal construction grants, and processes and submits claims for payment. Special emphasis is given to the need for the development of written programmes for proposed construction projects. Hospitals are assisted by this Division in the preparation of such programmes which provide architects and their engineering consultants with basic planning criteria for the logical development of plans. A great deal of time is spent in reviewing plans of proposed building projects, both at the sketch-plan stage and the working-drawing stage. Drawings and the architectural programme, which evolves from the hospital's functional programme, are reviewed with the various professions either existing in the Consultation, Finance, or Medical Consultation Divisions, or allied organizations such as the Radiology Advisory Council and the Laboratory Advisory Council. Reviews are made with several objectives, but basically the intent is to ensure that, in terms of the construction funds available, the greatest benefit will obtain and that funds are distributed in an equitable fashion. Thus remarks are made including consideration on alternate solutions which may produce a better plan for the same amount of money, on items which are felt might have an unwarranted influence on operating costs, and on items which are felt to be not in keeping with the philosophy of the lower initial cost consistent with good service and acceptable standards. Such remarks may be supported by alternate suggestions. During the year, liaison was maintained with the mechanical engineering profession in recognition of the need to design high-quality mechanical systems that would make a maximum contribution toward an efficient and economical hospital operation. Some of the elements included in designs for mechanical systems for new hospital buildings that reflect this approach included air recirculation and zoned heating and ventilating controls. The criteria for installation of heat recovery systems has now been completely reviewed in line with changes in interest rates on capital funds. Reduced application of air-conditioning systems has been included in new projects in recognition of the need to provide over-all comfort and environmental levels within hospitals consistent with acceptable capital and operating costs. Satisfactory mechanical plant operation in hospitals will be considerably assisted by virtue of a new approach in the compilation of maintenance manuals which will also incorporate a system of planned preventive maintenance. Such schemes are being incorporated with the design stage of hospital projects. Consultative advice is given to hospitals as well as other departments of the Hospital Insurance Service in the fields of plant operation and equipment selection. Liaison was maintained with the Hospitals Committee of the Architectural Institute of British Columbia. The function of this committee is to review and endeavour to resolve problems arising out of hospital construction projects which affect members of the Architectural Institute. An architect on the Division's staff is a member of this committee. M 28 BRITISH COLUMBIA Hospital boards are provided with a complete consultative planning service through this Division and through the co-operation of Health Branch personnel, members of the medical and nursing professions, and divisions of the British Columbia Hospital Insurance Service. The Provincial Health Branch renders assistance through the Division of Public Health Engineering, the Technical Supervisor of Clinical Laboratory Services, and the Technical Supervisor of Radiology. Through the co-operation of the Provincial Department of Labour, the Office of the Inspector of Factories provided a consultative service to the British Columbia Hospital Insurance Service on proposals for elevators and dumb-waiter installations in hospitals. Continuing benefit was derived from the co-operation of the Department of Public Works by assigning architects to this Division. With this architectural assistance it has been possible to prepare, in a number of cases, sketch-plans in support of layouts representing the Service's recommended approach to planning problems. During 1968 the architects and engineer attached to the Division made a number of inspectional visits to hospitals throughout the Province, and one visit was made to several hospitals in the Toronto area. The Division provided architectural and engineering representation on the sub-committee of the B.C.H.I.S. Planning Group which had the responsibility of developing a programme for design of 150-bed extended care hospitals. This subcommittee will remain active during the compilation, by an architectural team, of drawings and descriptions of all the components of a model extended care hospital. At the end of March, Mr. A. W. E. Pitkethley, Manager of the Construction Division for 19 years, retired and was replaced by Mr. John G. Glenwright, formerly of the Consultation Division, who filled the position until October, at which time he resigned to become the administrator of the Matsqui-Sumas-Abbotsford General Hospital. The position of Manager of the Division at the time of writing this report had not been filled. Mr. O. B. Padden, who was attached to the Division as a senior architect for approximately 10 years, left the Service in June to take up private practice. (a) Hospital Projects Completed during 1968 Campbell River and District General Hospital, Campbell River.—A new wing for extended-care patients was opened at this hospital on July 13, 1968. The unit contains 25 beds plus unfinished space for 15 more beds. St. Joseph's General Hospital, Comox.—The final stage of expansion programme at the Comox hospital was completed when a 45-bed extended-care unit was officially opened on September 7, 1968, in a renovated wing of the old hospital. This unit is connected to the new acute hospital, completed last year, from which it will receive services. Cranbrook and District Hospital, Cranbrook.—On August 31, 1968, the Honourable Ralph R. Loffmark, Minister of Health Services and Hospital Insurance, opened the new hospital complex at Cranbrook, consisting of a new acute hospital of 75 beds, plus space for 15 additional beds when required in the future, and a wing for 35 extended-care beds. Enderby and District Memorial Hospital, Enderby.—A construction programme consisting of additions and renovations to this hospital, including an increase of 3 beds, was finished in November of this year. Providence Hospital, Fort St. John.—A further 15 beds were completed and brought into service this year, bringing the total capacity of the hospital up to 100 beds. HOSPITAL INSURANCE SERVICE, 1968 M 29 Royal Inland Hospital, Kamloops.—Renovations were carried out to provide a 3-bed renal-failure unit. Langley Memorial Hospital, Murrayville.—The old hospital building at this hospital was renovated to accommodate 40 extended-care and 10 activation patients. This unit was officially opened on February 11, 1968. Royal Columbian Hospital, New Westminster.—A project to increase and improve the electrical service to the Royal Columbian Hospital was completed by the year-end. Pouce Coupe Community Hospital, Pouce Coupe.—The Honourable Donald L. Brothers opened a 26-bed extended-care unit at this hospital on October 26, 1968. The construction programme also included the expansion of the kitchen, administrative area, etc., and renovations to the existing hospital. Powell River General Hospital, Powell River.—On July 5, 1968, an addition and alterations project was officially opened by the Honourable Ralph R. Loffmark at Powell River. The programme resulted in a 26-bed extended-care unit, with space for 8 future beds and a new and enlarged emergency department and kitchen, cafeteria, etc. Prince George Regional Hospital, Prince George. — The services expansion project, consisting of additions and renovations to provide enlarged laboratory, radiological and emergency departments, etc., was completed at this hospital. Mills Memorial Hospital, Terrace.—This hospital has added a new floor containing patients' beds over an existing first-floor service area, and an addition at the main-floor level accommodating new emergency and physiotherapy and occupational-therapy departments and an enlarged laboratory and X-ray department. The new area, including a 4-bed intensive-care unit, was ready for patients in December, although the project, including renovations, is not to be officially opened until January, 1969. When the programme is finished, the hospital will have a capacity of 87 acute beds. British Columbia Cancer Institute, Vancouver.—An addition to the building to provide further radiotherapy facilities was completed this year. Louis Brier Hospital, Vancouver.—The Jewish Home for the Aged of British Columbia Society has completed the construction of a combined extended-care unit of 60 beds and 50-bed boarding home. The two units share lounge, physiotherapy and occupational therapy, administrative, kitchen, and laundry facilities. St. Paul's Hospital, Vancouver.—A major renovation programme, begun in 1966, was finished this year. The projects involved the dietary department, four elevators, a medical intensive-care unit, new sisters' quarters, premature nursery and special-care unit for children, the extension of the recovery room, provision of an isotope laboratory and X-ray special-procedures room, as well as other extensive renovations in the basement and on the main floor. Vancouver General Hospital, Vancouver.—The Honourable Wesley D. Black opened the 12-bed renal-failure unit at this hospital on May 1, 1968. Vernon Jubilee Hospital, Vernon.—A programme of extensive alterations, as well as additions, including a 60-bed extended-care wing, was completed and officially opened by the Minister of Health Services and Hospital Insurance, the Honourable Ralph R. Loffmark, on June 20, 1968. The hospital now has a total of 117 acute beds, including an 11-bed psychiatric unit, a new surgical suite and kitchen, and enlarged emergency, X-ray, laboratory, and physiotherapy departments. 1949 1952 51 ■ ■ . * ' Fernie. Burnaby. 1958 These photographs ar pitals which have bet past 20 years. Thf grants-in-aid amountii total costs 1953 1954 ■IIII1IKS (IIf1111 f! [■IIIHJ iiumiiimi III! Abbotsford. iff! ■ ■ ■ '-—*.%—- "v _. Pjg. Vancouver (St. Vincent's). 1959 als the over 50 new hos- Columbia during the rnment has provided 68,000,000 toward the onstruction. ItlCljl Vancouver (Centennial Building, Vancouver General Hospital). 1963 Fort St. John. Nanaimo. 1968 Comox. M 32 BRITISH COLUMBIA Peace Arch District Hospital, White Rock.—The new acute hospital at White Rock was opened by the Honourable Ralph R. Loffmark on July 4, 1968. The new building contains 106 acute beds and diagnostic, treatment, and service departments. The adjoining old hospital building was subsequently renovated to provide 42 extended-care beds. St. Joseph's Hospital, Victoria.—During the year extensive alterations, including electrical and mechanical revisions, were carried out to improve the radiological department. Royal Jubilee Hospital, Victoria. — A 4-bed coronary unit was brought into operation in March this year. (b) Projects under Construction at Year-end Matsqui-Sumas-Abbotsford General Hospital, Abbotsford.—Construction of an addition to increase the bed capacity to a total of 109 beds, plus 12 unfinished initially, and renovations to the existing hospital. Castlegar and District Hospital, Castlegar.—Construction of additions and renovations to provide a total of 60 acute beds. Creston Valley Hospital, Creston.—Construction of an addition and renovations to existing areas to provide a total of 44 acute beds, plus 8 unfinished. Kelowna General Hospital, Kelowna.—Construction of new acute block of 153 beds and enlarged service departments. Lillooet District Hospital, Lillooet.—Temporary prefabricated addition to provide 12 paediatric beds. Royal Columbian Hospital, New Westminster.—Renovation work to provide a 4-bed trauma unit in the emergency department. West Coast General Hospital, Port Alberni.—Completion of top floor and additional construction which will increase the hospital's capacity to 139 acute beds and 30 extended hospital care beds. The project includes renovations of existing areas and construction of additions to provide enlarged service departments. Princeton General Hospital, Princeton.—New 25-bed acute hospital. G. R. Baker Memorial Hospital, Quesnel.—Completion of 22 beds and renovations. Queen Victoria Hospital, Revelstoke.—Construction of new 50-bed hospital with space for 10 more beds. Surrey Memorial Hospital, Surrey.—Construction of new additions to provide a further 150 finished beds and 108 unfinished, plus renovation of the existing hospital. Trail-Tadanac Hospital, Trail.—Two separate projects are currently under way—one to provide a regional laboratory and 24-bed psychiatric unit and the other a 50-bed extended hospital care unit. Canadian Red Cross Society, British Columbia-Yukon Division, Vancouver.— New facilities for its blood transfusion service. Children's Hospital, Vancouver.—Metabolic investigation unit. Royal Jubilee Hospital, Victoria.—Major laboratory addition and renovation. (c) Projects in Advanced Stages of Planning Lady Minto Hospital, Ashcroft.—Replacement. Burnaby General Hospital, Burnaby.—Expansion and renovation programme. Burns Lake and District Hospital, Burns Lake.—Additions and renovations. Chetwynd and District Hospital, Chetwynd.—New facility of 30 beds. Chilliwack General Hospital, Chilliwack.—Additions and renovations. HOSPITAL INSURANCE SERVICE, 1968 M 33 Fort St. James Hospital, Fort St. James.—New facility of, 25 beds. Fraser Canyon Hospital, Hope.—Expansion and renovations. Victorian Hospital, Kaslo.—Replacement. Kelowna General Hospital, Kelowna.—Extended-care unit and renovations. Nanaimo Regional General Hospital, Nanaimo.—Additions and renovations. Royal Columbian Hospital, New Westminster.—Additions and renovations. Lions Gate Hospital, North Vancouver.—Extended-care unit. Penticton Hospital, Penticton.—Expansion, renovations, and extended-care unit. Prince Rupert General Hospital, Prince Rupert.—Replacement. Shuswap Lake General Hospital, Salmon Arm.—Expansion. St. Mary's Hospital, Sechelt.—Expansion programme and extended-care unit. Surrey Memorial Hospital, Surrey.—Extended-care unit. Vancouver General Hospital, Vancouver.—Extended-care unit and Willow Pavilion renovations, also construction of haemodialysis training unit. St. Paul's Hospital, Vancouver.—Renovation and expansion programme. Health Sciences Centre, University of British Columbia, Vancouver.—New hospital facility (Stage III). St. John Hospital, Vanderhoof.—Replacement. Windermere District Hospital, Invermere.—Expansion. (d) Additional Projects Approved and in Various Planning Stages in 1968 R. W. Large Memorial Hospital, Bella Bella.—Replacement. Campbell River and District General Hospital, Campbell River.—Expansion of acute hospital. St. Joseph General Hospital, Dawson Creek.—Expansion. Cowichan District Hospital, Duncan.—Extended-care unit. Fernie Memorial Hospital, Fernie.—New hospital to serve Fernie and Michel areas. Golden and District General Hospital, Golden.—Expansion and 4-bed extended-care unit. Boundary Hospital, Grand Forks.—Completion of 5 acute beds and provision of 14 extended-care beds. Wrinch Memorial Hospital, Hazelton.—Replacement of acute hospital plus 7 extended-care beds. Royal Inland Hospital, Kamloops.—Expansion, including extended-care unit, psychiatric and activation/rehabilitation beds. Lillooet District Hospital, Lillooet.—Expansion of acute beds plus approval to plan 6 extended-care beds. Arrow Lakes Hospital, Nakusp.—New hospital to serve Nakusp and New Denver. Lions Gate Hospital, North Vancouver.—Expansion of services. Ocean Falls General Hospital, Ocean Falls.—Replacement. St. Martin's Hospital, Oliver.—Replacement. Richmond General Hospital, Richmond.—Extended-care unit. Bulkley Valley District Hospital, Smithers.—Expansion. Squamish General Hospital, Squamish.—Renovations and improvements. Prince George Regional Hospital, Prince George.—Expansion programme. Children's Hospital, Vancouver.—Replacement. Holy Family Hospital, Vancouver.—New activation unit and renovation of existing building for extended care. M 34 BRITISH COLUMBIA Mount St. Joseph Hospital, Vancouver.—New acute unit and renovation of existing hospital for extended care. St. Vincent's Hospital, Vancouver.—Expansion and renovations and extended- care unit. G. F. Strong Rehabilitation Centre, Vancouver.—Expansion. Vancouver General Hospital, Vancouver.—New activation/rehabilitation unit. Priory Hospital, Victoria.—Extended-care unit. Royal Jubilee Hospital, Victoria.—Renovations. St. Joseph's Hospital, Victoria.—Expansion. Cariboo Memorial Hospital, Williams Lake.—Expansion. Director of Hospital Consultation, Development, and Research J. W. Mainguy, M.H.A. The Director is responsible for the operation of both the Hospital Consultation and Inspection Division and the Research Division, and is Assistant Chief Inspector of Hospitals under the Hospital Act, the Chief Inspector being the Deputy Minister. The Director is responsible for the administration of the Service in the absence of the Deputy and Assistant Deputy Minister. He is Chairman of the B.C.H.I.S. Planning Group and Vice-Chairman of the Hospital Rate Board. The work undertaken during the year in connection with these activities is outlined in pages 15 and 21 respectively. He represents the Service on a number of committees of government and community agencies, including the Co-ordinating Committee on Paramedical Training of the British Columbia Institute of Technology, Burnaby; the Liaison Committee between the Service and the British Columbia Hospitals' Association; and the Sub-committee on Quality of Care and Research, Ottawa. Reports of the activities undertaken by the two Divisions responsible to the Director follow. Hospital Consultation and Inspection Division J. Bainbridge, Manager This Division provides public and private hospitals with consultative services in all matters of hospital operation and administration. It is responsible for an inspectional programme to ensure basic standards are met, and for the licensing of private hospitals regardless of the type of care given. Its staff is composed of administrative, nursing, dietary, and management engineering consultants. The Division co-operates with all other divisions of the Service in achieving aims of mutual interest and responsibility. It is accountable for the analysis and subsequent recommendations for approved staffing patterns resulting from hospital estimates, both annual and otherwise, and the Manager is a member of the Hospital Rate Board. Staff members also participate in the planning function of British Columbia Hospital Insurance Service, including the review of the operational implications of construction projects and the setting of standards. Sketch-plans are analysed and assessed in conjunction with the Hospital Construction and Planning Division. The Division represents the Service on a large number of councils, committees, and working parties associated with hospitals and the health field, and works with Federal, Provincial, and municipal representatives on related matters. During 1968, 109 staff visits were made to acute, rehabilitation, chronic, convalescent, and extended care hospitals. In addition, 160 visits by nursing and other staff consultants were made to private hospitals giving nursing-home care. (Continued on page 36.) HOSPITAL INSURANCE SERVICE, 1968 M 35 A nursing consultant from the staff of the British Columbia Hospital Insurance Service is photographed during a routine hospital inspection. This is one of several professional counselling services available to the hospitals of the Province. .*«!% This standard (public) ward is typical of the accommodation available in British Columbia's modern hospitals. A 4-bed ward designed for the patient's comfort and convenience, it features reading-lamps, individual lockers, and a nurses' call system. Nurses' residence and training-school of the Royal Inland Hospital, Kamloops (1964). M 36 BRITISH COLUMBIA The Division's management engineering unit was expanded during the latter part of the year with the addition of three new members, and has been functioning at maximum capacity in response to numerous requests from hospitals for studies on a wide variety of subjects. These included studies on hospital organizational structure, dining arrangements in an extended care hospital, medical records departments and records storage, waste-disposal systems, central sterilizing systems, materials-handling, and the layout of a hospital's X-ray and laboratory services. Members of the unit have also taken part in hospital educational seminars to stimulate the use of work simplification in hospitals. A library of reference material is currently being assembled. Personnel of the Division attended a variety of educational sessions during the year, as a necessary means of keeping abreast of changing concepts and techniques in the hospital field. During 1968 Mr. J. G. Glenwright, administrative consultant, left the Division to become Manager of the Hospital Construction and Planning Division. Messrs. D. Giles and E. Zulkowski, administrative consultants; L. Mann, J. Reeve and F. Lohner, management engineering consultants; and Miss J. DesJardins, nursing consultant, all joined the staff of the Division during the year. The Division continues to process an increasing number of requests for statistical information pertaining to morbidity data and hospitalization experience. Research Division D. S. Thomson, B.A., Director The Research Division is responsible for compiling and maintaining statistical data relating to hospitalization and morbidity in British Columbia. The Admission- Separation Records submitted by the hospitals for each in-patient serve as the major source of reference in deriving statistical information. The data used are keypunched by the Hospital Claims Section of this Service and then transferred to magnetic tape by the Data Processing Division of the Department of Industrial Development, Trade, and Commerce, which prints out the required tabulations. The hospital data are used extensively in the bed requirement studies that the Division carries out each year, and are also made available to independent consultants engaged in similar studies. These studies, which become the basis of hospital planning decisions, have become increasingly important as the newly formed regional hospital districts become active in hospital planning. To aid in these studies, the Research Division makes an annual review of economic and population growth and prepares population estimates for the Province's school districts. School districts also serve as convenient planning areas for bed studies, and by grouping these districts together to correspond with the regional hospital district areas, it is possible to gather relevant hospital data. The Division is responsible for the publication of several annual bulletins which have, over the years, been useful to various research groups and agencies throughout the Province and Canada. " Statistics of Hospital Cases Discharged in 1967 " includes 10 standard morbidity tables as suggested by the Federal Advisory Committee on Hospital Insurance and Diagnostic Services, along with an analysis of the Province's hospitalization experience by race, age, geographical location, major diagnostic group, and type of service. " Statistics of Hospitalized Accident Cases " provides a broad analytical coverage of hospitalized accidents by circumstance, type of accident, and by nature of injury. Another bulletin prepared and issued by the Division was an Alphabetical Listing of Place-names in British Columbia with Geographical Code. In addition, a number of statistical tables entitled HOSPITAL INSURANCE SERVICE, 1968 M 37 " Hospital Indicators " were circulated to all hospitals. These indicators allow the individual hospital to focus attention on its own performance as well as making a comparison with hospitals of a similar size-group. A further series of reports produced by this Division involved an analysis of patient-flow patterns within five of the larger regional hospital districts. In connection with the 10 standard morbidity tables approved in 1961, a working party was convened in Ottawa, February 12 to 16, 1968, at the request of the Advisory Committee on Hospital Insurance, to review hospital morbidity statistics. The working party, which included the Director of the Research Division, developed proposals for uniform reporting of hospital morbidity data. As the field of hospital development takes on an increasing and more complex role in the provision of health care, a continuing study is being made of the assessment of hospital bed needs. With the co-operation of several hospitals regarding the utilization of their records, a waiting-list study was undertaken and completed during the year. A Province-wide study is presently being carried out to determine the over-all bed needs by school district and by regional hospital district to serve as a planning guide for future hospital programmes. Now in its final stage of completion, it is concerned with the patient movement among the regional hospital districts and among the major referral centres within the Province. Its object is to define these patterns of movement and, along with population projections, to ascertain the bed need requirements to a future date. The Division continues to process an increasing number of requests for statistical information pertaining to morbidity data and hospitalization experience. In November, 1968, Mr. D. Belton, B.Sc, joined the staff as a research officer, filling the position previously held by Mr. P. Pallan, who enrolled in a programme of hospital administration and is on an educational leave of absence. Medical Consultation Division C. F. Ballam, M.D., Medical Consultant The Admission-Separation Record for each patient admitted to a hospital either in British Columbia or while out of Province is assessed with regard to its medical aspects by this Division. This review includes coding according to the " International Classification of Diseases, Adapted for Indexing Hospital Records by Diseases and Operations," and is a function which requires the professional knowledge and training of medical coders. The competence and accuracy applied to this work is reflected in the statistical end-product, and to ensure a continuing high standard all coders at the British Columbia Hospital Insurance Service are graduate nurses. These statistical data are basic to planning decisions for expanding or developing hospital facilities generally and special departments in certain hospitals in particular. In addition, this coded information is utilized by the Research Division of the British Columbia Hospital Insurance Service and the Dominion Bureau of Statistics for the publication of hospital morbidity and mortality data. Other functions of the review include bed usage, identifying special area requirements by reason of geographical or industrial development, and assessing complicated individual cases when required. The Medical Record Consultant visited 20 hospitals during the year. On these visits, medical record department problems are identified, and assistance and advice are offered with a view to encouraging a high standard of medical recordkeeping, in accordance with the guidelines laid down by the Canadian Council on Hospital Accreditation. The needs of the British Columbia Hospital Insurance Service for statistical and research studies are also clarified with the hospital medical M 38 BRITISH COLUMBIA record personnel. Membership and participation on the Perinatal Morbidity and Mortality Study Committee of British Columbia and the Education Committee of the British Columbia Association of Medical Record Librarians is maintained, ensuring further liaison with hospital medical record personnel. In co-operation with such bodies as the Faculty of Medicine of the University of British Columbia, the College of Physicians and Surgeons of British Columbia, and other departments of government, special medical research projects have been a part of the work of this Division. These studies have been greatly benefited by legislation making the data of such studies privileged information and not subject to litigation. Extended care hospital coverage was introduced in December, 1965, and greatly increased the tasks of the Medical Consultation Division. The assessment and review of individual patients' applications continue to provide an increasing work load. A quarterly review of all extended care hospitals is undertaken, with two purposes—(1) a medical audit, to ensure patients continue to be medically qualified for this benefit, and (2) for the purpose of reviewing and assisting in the treatment programme provided by the hospital—in order that the care which the patient receives is commensurate with current thinking in the management of chronically disabled individuals. The Medical Consultation Division has the assistance of qualified consultants in physical medicine to bring the weight of their specialized knowledge to this programme. Several new extended-care units were opened during the year, increasing the application review load, but additionally demanding professional consultation to implement treatment programmes in these new units. Dr. D. G. Adams, Assistant Medical Consultant, has major administrative supervisory responsibility for the Coding Division and the survey and review projects previously mentioned. In addition, administration of the medical aspects of the extended-care programme is under his supervision. Management of the day-today problems which arise in the administration of these matters enables Dr. Adams to participate with the Medical Consultant in the preparation of policy recommendations to the Deputy Minister, with the anticipation that Service policy can be adjusted to meet current hospital conditions and needs. In February, 1968, day-care surgical services were approved as a hospital insurance benefit. Legislation has therefore been adopted to accommodate an altering pattern of medical practice. This form of practice has improved the utilization of our health facilities, and the Medical Consultant continues to advise the Service in its planning for an expanded role in ambulatory patient-care. In a similar fashion to the in-patient admission records, all day-care surgical services records are assessed and coded according to the International Classification of Diseases, so that these data may be tabulated and the subject of statistical review. The Medical Consultant, while maintaining responsibility for the foregoing, also ensures active liaison through visits to hospitals, special disease groups, societies, and health agencies. Liaison with the British Columbia Medical Association, and active participation on its Hospitals Committee and the Advisory Sub-committee for Chronic Renal Failure, continued during the year. New committees to consider radioisotope facilities and intensive coronary-care services were set up by the British Columbia Medical Association at our request, and both Medical Consultants participate directly with these advisory bodies. The encouragement of hospitals to achieve accreditation standards imposes certain pressures to conform to the requirements of accreditation, and when these pressures produce problems for the medical staff of the hospital, the Medical Consultant is able, with the assistance of the Hospital Consultation and Inspec- HOSPITAL INSURANCE SERVICE, 1968 M 39 tion Division, to render assistance. The Medical Consultant gives advice to this Service on the proposed addition or extension of medical services in hospitals. It follows that new treatment services require additional equipment, and today not only must the traditional hospital departments be supplied with modified equipment, but new technology in the bio-medical sciences is introducing new diagnostic and treatment services, often demanding equipment which was unheard of 5 to 10 years ago. There is a constant and rising demand to keep abreast of the change in medicine and to call upon ancillary consultative advice from specially talented individuals, as well as organized technical groups from the profession. The resources of other Government departments—namely, the Health Branch and Mental Health Services—are utilized where problems are related to these special fields, and particularly where the treatment services being made available in acute general hospitals must be complementary to those services being provided through Health Branch and mental health agencies; additionally, of course, the Social Welfare Department is similarly involved. The Medical Consultant and the Assistant Medical Consultant participate in the postgraduate continuing medical education programmes sponsored through the university and the British Columbia and local medical societies, as well as special and pertinent continuing medical education seminars or courses offered outside British Columbia. Administrative Officer K. G. Wiper The Administrative Officer is responsible for the drafting of legislation, regulations, and Orders in Council for the British Columbia Hospital Insurance Service. In the performance of these duties, a close working relationship exists between this office and the Attorney-General's Department. Hospital societies may apply to the Administrative Officer for assistance in connection with the drafting of hospital constitutions and by-laws, and their interpretation and application. Changes in hospital by-laws are reviewed by this office prior to their submission for Government approval as required under the Hospital Act. A set of model by-laws has been developed for use by hospitals as a guide in making revisions. Under the Regional Hospital Districts Act, described earlier in this Report, the Administrative Officer has worked closely with the officials of other departments and of the various districts in establishing regional hospital districts, arranging for money by-laws, temporary borrowing, and related matters. In collaboration with the Hospital Consultation and Inspection Division, the Administrative Officer processes, for approval under section 14 of the Hospital Act, transfers of private-hospital property and transfers of shares in the capital stock of private-hospital corporations. In addition, close liaison is maintained with the Land Registry Office to ensure that the property records of both general hospitals and private hospitals are suitably endorsed so that land transfers are not made until they are approved under sections 14 (2) and 41 (1) (c) of the Hospital Act. As in previous years, considerable time was spent in 1968 on matters related to the Federal-Provincial hospital insurance arrangements. Methods of streamlining administrative procedures and improving liaison were discussed with officials of the Federal Government and other Provinces at meetings held in Ottawa and Victoria. The Administrative Officer is the Personnel Officer for the British Columbia Hospital Insurance Service. He is also responsible for the over-all supervision of the General Office and the Third Party Liability and the Eligibility Sections. M 40 BRITISH COLUMBIA Eligibility Representatives' Section P. A. Bacon In order to ensure that only qualified British Columbia residents receive hospital insurance benefits, the staff of the Eligibility Section review the Applications for Benefits made by, or on behalf of, persons admitted to hospital. A detailed check is made of all doubtful applications, resulting in the rejection of a considerable number of claims for hospital insurance benefits made by unqualified persons. Numerous inquiries from the general public with regard to eligibility matters are dealt with by personal interview, telephone, and correspondence. Eligibility Representatives visit hospitals on a regular schedule to see that the British Columbia Hospital Insurance Service eligibility procedures are being properly carried out. The Representatives also assist in the training of hospital admitting personnel to deal with problems connected with the admission of patients to hospitals and the determination of their status under the Hospital Insurance Act. This training assistance is provided by means of visits to hospitals and by regional meetings. This Section keeps the great majority of employers in British Columbia supplied with certificates on which an employee's length of employment can be certified. The Representatives maintain close liaison with these firms to ensure their continuing co-operation in providing their employees with this form of proof of residence for hospital insurance purposes. Close liaison is maintained with the British Columbia Medical Plan, and Eligibility Representatives supply Medical Plan applications and information to the general public in many communities throughout the Province. Regional representatives are located in Prince George, Kamloops, Nelson, and Kelowna, as well as in Vancouver and Victoria. Third Party Liability Section J. W. Brayshaw 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 expenses paid by this Service on behalf of accident victims. The Senior Eligibility Representative in Vancouver, Mr. H. E. Drab, is 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 the Vancouver office, and negotiations may be carried out in person or by telephone, thus avoiding the necessity of corresponding with the head office in Victoria. General Office C. R. Leighton The supervision of internal administrative accounting, purchasing, payroll, and supplies continued to be the main function of the General Office. The preparation of annual Departmental estimates is also a responsibility of this office, and this is done in consultation with Division Managers. The General Office provided assistance to the Construction and Planning Division in processing grants toward hospital alterations and renovations, and also provided periodic stenographic services to various other offices during the year. HOSPITAL INSURANCE SERVICE, 1968 M 41 The Supervisor, in his capacity of Safety Officer, prepared a number of circulars for hospitals dealing with various aspects of hospital safety. These circulars were prepared in conjunction with the Hospital Consultation and Inspection Division. Articles dealing with hospital safety are prepared for each issue of the British Columbia Hospital Insurance Service " Bulletin." Public Information R. H. Thompson This office is responsible for the continuing development of public information activities and concerns itself with three main areas of responsibility, which are the general public, hospitals, and in-service duties. The following is a summary of the work undertaken during 1968. With increased activity on the part of hospitals in developing in-service training programmes, considerable effort was made during the year to augment the audio-visual aids available to hospitals from the British Columbia Hospital Insurance Service film library. Staff consultants viewed 18 motion-picture films on various subjects, and two filmstrip series which dealt with long-term care and hospital housekeeping. As a result of these screenings, both filmstrip series were purchased, as well as two 16-mm. films on the subjects of management engineering and hospital fire safety. Growing interest on the part of hospitals in audio-visual presentations was shown in the increased use made of the film library in 1968, when an estimated 3,500 hospital staff viewed 178 separate film presentations. The availability of these films on a loan basis makes it unnecessary, in many instances, for hospitals to purchase their own films for in-service training. Revision of the British Columbia Hospital Insurance Service Manual on Policy, Organization and Procedures was continued, and several replacement pages were printed, together with a revised 25-page index. Approximately 150 pages of the original 270-page manual have now been replaced, and 29 pages have been added. Minor revisions were made to the B.C.H.I.S. exhibit at the British Columbia Building at the Pacific National Exhibition. It is anticipated that the entire Departmental display will require major renovations in the near future in order to make it as attractive and interesting as possible. The " General Information " pamphlet was again revised and reprinted, and early in the new year copies will be forwarded to civic organizations, business and industry, Government Agents, and " Welcome Wagon " representatives. The volume of press releases issued during the year increased considerably, as efforts were made to ensure that the public, through the news media, was kept aware of various hospital construction programmes, Governmental policy changes, and other items of public interest. Regular editions of the B.C.H.I.S. Bulletin were published during the year for distribution to all public hospitals and licensed private hospitals. The B.C.H.I.S. Bulletin is an administrative aid used to clarify policy and procedural changes for hospital personnel as well as publishing articles of general interest. January 1, 1969, will mark the 20th anniversary of the British Columbia Hospital Insurance Service, and a publicity programme to commemorate the event included the development of a display for public exhibition, and preparation of special material for distribution to the news media. Other duties included the drafting of speeches, the summarizing of reports for the information of the Deputy Minister, maintaining the newspaper and hospital photograph files, replying to general correspondence, and the preparation and editing of the 20th Annual Report. M 42 BRITISH COLUMBIA APPROVED HOSPITALS Public Hospitals Armstrong and Spallumcheen Hospital, Armstrong. Arrow Lakes Hospital, Nakusp. Bella Coola General Hospital, Bella Coola. Boundary Hospital, Grand Forks. British Columbia Cancer Institute, Vancouver. Bulkley Valley District Hospital, Smithers. Burnaby General Hospital, Burnaby. Burns Lake and District Hospital, Burns Lake. Campbell River and District General Hospital, Campbell River. Cariboo Memorial Hospital, Williams Lake. Castlegar and District Hospital, Castlegar. Chemainus General Hospital, Chemainus. Children's Hospital, Vancouver. Chilliwack General Hospital, Chilliwack. Cowichan District Hospital, Duncan. Cranbrook and District Hospital, Cranbrook. Creston Valley Hospital, Creston. Cumberland General Hospital, Cumberland. Enderby and District Memorial Hospital, Enderby. Esperanza General Hospital, Esperanza. Fernie Memorial Hospital, Fernie. Fort Nelson General Hospital, Fort Nelson. Fraser Canyon Hospital, Hope. G. R. Baker Memorial Hospital, Quesnel. Golden and District General Hospital, Golden. Grace Hospital, Vancouver. Kelowna General Hospital, Kelowna. Kimberley and District Hospital, Kimberley. Kitimat General Hospital, Kitimat. Kootenay Lake General Hospital, Nelson. Lady Minto Hospital, Ashcroft. Lady Minto Gulf Islands Hospital, Ganges. Ladysmith and District General Hospital, Lady smith. Langley Memorial Hospital, Murrayville. Lillooet District Hospital, Lillooet. Lions Gate Hospital, North Vancouver. McBride and District Hospital, McBride. Maple Ridge Hospital, Haney. Mater Misericordiae Hospital, Rossland. Matsqui, Sumas, and Abbotsford General Hospital, Abbotsford. Michel-Natal District Hospital, Michel. Mills Memorial Hospital, Terrace. Mission Memorial Hospital, Mission City. Mount St. Joseph Hospital, Vancouver. Nanaimo Regional General Hospital, Nanaimo. Nicola Valley General Hospital, Merritt. Ocean Falls General Hospital, Ocean Falls. 100 Mile District General Hospital, 100 Mile House. Peace Arch District Hospital, White Rock. Penticton Hospital, Penticton. Pouce Coupe Community Hospital, Pouce Coupe. Powell River General Hospital, Powell River. Prince George Regional 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. Rest Haven Hospital and Sanitarium, Sidney. Richmond General Hospital, Richmond. 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 General Hospital, Dawson Creek. St. Joseph's General Hospital, Comox. St. Joseph's Hospital, Victoria. St. Martin's Hospital, Oliver. St. Mary's Hospital, New Westminster. St. Mary's Hospital, Sechelt. St. Paul's Hospital, Vancouver. St. Vincent's Hospital, Vancouver. Shuswap Lake General Hospital, The, Salmon Arm. Slocan Community Hospital, New Denver. Squamish General Hospital, Squamish. Stewart General Hospital, Stewart. Summerland General Hospital, Summerland. Surrey Memorial Hospital, North Surrey. 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. West Coast General Hospital, Port Alberni. Windermere District Hospital, Invermere. Wrinch Memorial Hospital, Hazelton. * Ceased operation September 14, 1968, and replaced by Cranbrook and District Hospital, Cranbrook. HOSPITAL INSURANCE SERVICE, 1968 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. M 43 Edge- Red Cross Outpost Nursing Station, wood. Red Cross Outpost Nursing Station, Kyuquot. Red Cross Outpost Nursing Station, Masset. Red Cross Outpost Nursing Station, Wad- hams. Federal Hospitals Veterans' Hospital, Victoria. Shaughnessy Hospital, Vancouver. Coqualeetza Indian Hospital, Sardis. Miller Bay Indian Hospital, Prince Rupert. R.C.A.F. Station Hospital, Holberg. Licensed Private Hospitals Industrial Hospitals in Remote Areas with Which the Province Has Entered into an Agreement Requiring Them to Furnish the General Hospital Services Provided under the Hospital Insurance Act. Bralorne Private Hospital, Bralorne. Port Alice Private Hospital, Port Alice. Cassiar Asbestos Corporation Private Hos- Tasu Hospital, Tasu Sound, Queen Char- pital, Cassiar. lotte Islands. Mica Creek Private Hospital, Mica Creek. Other Hollywood Hospital Ltd., New Westminster (licensed under the Mental Health Act). Rehabilitation, Chronic, and Convalescent Hospitals Berkeley Private Hospital, White Rock.* G. F. Strong Rehabilitation Centre, Vancouver. The Gorge Road Hospital, Victoria. Holy Family Hospital, Vancouver. Pearson Hospital (Poliomyelitis Pavilion), Vancouver. Queen Alexandra Solarium for Crippled Children, Victoria. Shaughnessy Hospital, Vancouver. Sunny Hill Hospital for Children, Vancouver. Veterans' Hospital, Victoria. (A number of the larger public hospitals also have rehabilitation units.) * Became part of Peace Arch District Hospital, November 27, 1968. Extended Care Hospitals Mount St. Mary Hospital, Victoria (excluding top floor). Mount St. Francis Hospital, Nelson. Mount St. Joseph Hospital, Vancouver (top floor). Menno Hospital, Abbotsford. Priory Hospital, Colwood (24-bed unit and 71-bed unit). Pearson Hospital, Vancouver (excluding facilities for tuberculosis patients). Valleyhaven Hospital, Chilliwack. Veterans' Hospital, Victoria (extended-care unit). Shaughnessy Hospital, Vancouver (extended- care unit). The Louis Brier Hospital, Vancouver.* * Opened December 22, 1968. 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 British Columbia Hospital Insurance Service. In 1968 there were 90 public general hospitals approved to accept British Columbia Hospital Insurance Service patients. Care was also M 44 BRITISH COLUMBIA provided in eight outpost hospitals, five Federal hospitals, seven contract hospitals, five public rehabilitation hospitals, and one rehabilitation hospital operated by the Provincial Government. Hospital insurance coverage for patients in non-profit extended care hospitals and units commenced December 1, 1965. At the end of 1968 there were 20 hospitals providing extended care. Data for the year 1968 had been estimated from reports submitted by hospitals to October 31st, and are subject to minor revision when actual figures for the year are submitted. Table 1a shows that a total of 328,433 British Columbia Hospital Insurance Service adult and children patients were separated (discharged) from British Columbia hospitals in 1968, an increase of 16,715 or 5.3 per cent over 1967. This table also shows that 95.7 per cent of the total patients separated (discharged) from British Columbia public hospitals were covered by hospital insurance, compared to 95.2 in 1966 and 95.3 in 1967. Table 1b indicates in 1968 that the British Columbia Hospital Insurance Service paid public hospitals in British Columbia for 3,099,840 days of care for adults and children, an increase of 153,840 days or 5.2 per cent over 1967. As shown in Table 2a, the average length of stay of British Columbia adult and children patients in public hospitals during 1968 was 9.44 days, and the days of care per thousand population were 1,771. For comparison purposes, the data for extended care hospitals is not included in the above observations, but it should be noted that an additional 202 days of care per thousand population were provided for these patients. Table 2b, under " Minor Surgery Patients," includes an estimated 11,500 daycare surgery patients from March 1, 1968. An additional estimated 30,000 outpatient cancer treatments were covered by the British Columbia Hospital Insurance Service, which are not included in this table. HOSPITAL INSURANCE SERVICE, 1968 M 45 Table 1a. — Patients Separated (Discharged or Died) and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public Hospitals Only, 1949-68 (Excluding Federal, Private, and Out-of-Province Hospitalization) (Including Rehabilitation Hospitals). Total Hospitalized Hospitals in Public Covered by B.C.H.I.S. Adults and Children Newborn Total Adults and Children Newborn Total Patients separated— 1949 164,964 172,645 181,160 188,355 200,893 206,992 216,743 227,359 228,917 236,859 245,766 261,128 271,609 277,073 285,998 292,119 301,510 314,585 326,793 342,602 26,272 26,205 27,096 28,675 30,712 31,984 33,190 35,118 37,376 38,374 39,039 39,599 38,226 37,697 37,231 35,688 33,555 32,488 32,014 32,786 191,236 198,850 208,256 217,030 231,605 238,976 249,933 262,477 266,293 275,233 284,805 300,727 309,835 314,770 323,229 327,807 335,065 347,073 358,807 375,388 140,168 144,959 150,116 154,336 169,167 189,713 199,774 208,293 209,485 222,046 234,783 249,654 259,953 264,655 272,597 278,023 286,799 299,518 311,718 328,433 84.9 84.0 82.9 81.9 84.2 91.7 92.2 91.6 91.5 93.7 95.5 95.6 95.7 95.5 95.3 95.2 95.1 95.2 95.4 95.9 24,640 23,943 24,172 25,023 27,830 29,483 31,515 33,174 34,963 37,045 38,480 38,980 37,558 36,505 35,878 34,196 31,863 30,814 30,377 30,841 93.8 91.4 89.2 87.3 90.6 92.2 95.0 94.5 93.5 96.5 98.6 98.4 98.3 96.8 96.4 95.8 95.0 94.8 94.9 94.1 164,808 1950 168,902 1951 174,288 195?. 179,359 1953 196,997 1954 219,196 1955 231,289 1956 241,467 1957 244,448 1958 259,091 1959 - 1960 273,263 288,634 1961-... - . 1962 297,511 301,160 1963. 308,475 1964 1965 312,219 318,662 1966 330,332 19671 19682.. Percentage of total, patients separated— 1949 342,095 359,724 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 1958 94.1 1959 ... 95.9 1960 96.0 1961 .. 96.0 1962... 95.7 1963 95.4 1964 95.2 1965. ... 95.0 1966 95.2 19671 ___ 95.3 19682 95.7 1 Amended as per final reports received from hospitals. 2 Estimated, based on hospital reports to October 31, 1968. M 46 BRITISH COLUMBIA Table 1b.—Total Patient-days and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public Hospitals Only, 1949-68 (Excluding Federal, Private, and Out-of-Province Hospitalization) (Including Rehabilitation Hospitals). Total Hospitalized in Public Hospitals Covered by B.C.H.I.S. Adults and Children Newborn Total Adults and Children Newborn Total Patient-days— 194Q 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 2,407,134 2,581,042 2,675,402 2,708,337 2,778,668 2,820,122 2,895,476 3,008,632 3,093,372 3,246,340 213,874 212,979 214,285 214,701 220,208 226,031 227,674 233,402 240,872 244,429 248,074 249,273 240,207 274,032 270,298 260,979 245,756 235,796 239,972 242,047 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 2,655,208 2,830,315 2,915,609 2,982,369 3,048,966 3,081,101 3,141,232 3,244,428 3,333,344 3,488,387 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 2,275,127 2,451,839 2,546,344 2,573,634 2,631,671 2.670.176 200,585 193,307 187,891 184,160 197,100 213,587 212,514 217,252 223,079 232,390 239,871 241,157 231,043 263,475 257,736 246.813 1,631,231 19SO 1,669,922 19S1 1,654,993 19 V? 1,754,134 1953 - - _ 19S4 1,909,978 2,168,410 19SS 2,217,679 1956 1957 - - 2,259,106 2,299,415 19<!R 2,402,287 1959 2,514,998 10fiO 2,692,996 1961 2,777,387 19fi? 2,837,109 19M 2,889,407 19fi4 2,916,989 1965 2.747.232 1 230.096 2,977,328 1966 19671 - 19682 Percentage of total, patient-days— 1940 2,861,260 2,946,000 3,099,840 85.0 83.6 81.7 81.9 83.9 90.4 91.2 91.2 91.2 93.4 94.5 95.0 95.2 95.0 94.7 94.7 94.0 95.1 95.2 95.5 220,270 222,543 222,867 93.8 90.8 87.7 85.8 89.5 94.5 93.3 93.1 92.6 95.1 96.7 96.7 96.1 96.1 95.4 94.6 93.0 93.4 92.7 92.1 3,081,530 3,168,543 3,322,707 86.0 19S0 84.4 19S1 82.3 19S? 82.3 1953 84.4 1954 90.8 19ss 91.4 19S6 91.3 19<i7 91.3 1958 93.6 1959 94.7 I960 95.1 1961 95.3 1962 - 95.1 1963 94.8 1964 . 94.7 1965 94.0 1966 95.0 19671.- 95.0 19682 _ 95.3 i Amended as per final reports received from hospitals. 2 Estimated, based on hospital reports to October 31, 1968. HOSPITAL INSURANCE SERVICE, 1968 M 47 Table 2a.—Patients Separated, Total Patient-days, and Average Length of Stay According to Type and Location of Hospital for B.C.H.I.S. Patients Only, and Days of Care per Thousand of Covered Population, 1949-68. Total (Excluding Extended Care) 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 Extended Care Hospitals (Including Federal) Patients separated- 1949. 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965- 1966 19671- 19682 Patient-days— 1949 1950 -- 1951 1952 1953 1954 1955 - 1956 1957 - 1958 1959 1960 1961 1962 1963 1964 1965 1966 19671 19fiS2 Average days stay— 1949 of 1950 1951 1952 - 1953 1954 1955 - 1956 - 1957 1958 1959 1960 1961 ~- - 1962 - 1963 -- 1964 1965 1966 19671 - 19682 149,280 154,643 159,739 164,379 180,149 199,974 209,999 219,218 221,585 236,770 251,393 264,120 273,293 278,021 286,753 293,144 301,522 314,391 325,861 342,081 1,498,121 1,564,222 1,551,954 1,663,149 1,814,344 2,046,087 2,100,386 2,141,445 2,188,765 2,332,502 2,474,974 2,650,129 2,756,665 2,789,355 2,850,559 2,905,544 2,985,092 3,110,701 3,189,212 3,330,213 10.03 10.11 9.71 10.12 10.07 10.23 10.00 9.77 9.88 9.85 9.85 10.03 10.09 10.03 9.94 9.91 9.90 9.89 9.79 9.74 24,989 24,336 24,587 25,492 28,381 29,761 32,035 33,783 35,813 37,924 39,257 39,488 37,968 36,942 36,326 34,652 32,240 31,152 30,804 31,216 203,197 196,333 190,948 187,923 200,738 215,507 215,980 221,022 228,875 238,112 244,615 244,480 233,794 266,351 260,771 249,827 232,438 222,475 225,479 225,157 8.13 8.07 7.76 7.37 7.07 7.24 6.74 6.54 6.39 6.28 6.23 6.19 6.16 7.21 7.18 7.21 7.21 7.14 7.32 7.21 140,168 144,959 150,116 154,336 169,167 189,713 199,774 208,293 209,485 222,046 234,783 249,654 259,953 264,655 | 272,597 I 278,023 | 286,799 | 299,518 | 311,718 | 328,433 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 2,275,127 2,451,839 2,546,344 2,573,634 2,631,671 2,670,176 2,747,232 2,861,260 2.946,000 3,099,840 10.21 10.19 9.77 10.17 10.13 10.30 10.04 9.80 9.91 9.77 9.69 9.82 9.80 9.72 9.65 9.60 9.57 9.55 9.45 9.44 24,640 23,943 24,172 25,023 27,830 29,483 31,515 33,174 34,963 37,045 38,480 38,980 37,558 36,505 35,878 34,196 31,863 30,814 30,377 30,841 200,585 193,307 187,891 184,160 197,100 213,587 212,514 217,252 223,079 232,390 239,871 241,157 231,043 263,475 257,736 246,813 230,096 220,270 222,543 222,867 8.14 8.07 7.77 7.36 7.08 7.24 6.74 6.55 6.38 6.27 6.23 6.19 6.15 7.22 7.18 7.22 7.22 7.15 7.32 7.23 7,093 7,617 7,308 7,431 8,173 7,602 8,313 9,473 10,023 12,506 13,908 11,557 10,361 10,226 10,895 11,605 11,417 11,459 9,436 9,048 45,960 65,326 62,771 68,892 75,518 66,960 75,599 79,428 93,980 141,925 173,343 169,401 182,690 183,042 187,714 199,164 205,488 | 212,413 | 195,564 1 184,373 6.48 j 8.58 | 8.59 | 9.27 | 9.24 | 8.81 | 9.09 | 8.38 9.39 11.35 12.46 14.66 17.63 17.90 17.23 17.16 18.00 | 18.53 | 20.72 | 20.38 j 151 173 171 161 229 199 361 457 668 665 514 241 151 157 169 149 114 101 83 75 1,146 1,288 1,155 974 1,353 1,251 2,271 2,740 4,299 4,113 2,818 1,417 878 850 1,018 878 619 541 451 390 7.59 7.44 6.75 6.05 5.91 6.29 6.29 6.00 6.44 6.19 5.48 5.88 5.81 5.41 6.02 5.89 5.43 5.36 5.43 5.20 2,019 2,067 2,315 2,612 2,809 2,659 1,912 2,050 2,077 2,218 2,702 2,909 2,979 3,140 3,261 3,516 3,306 3,414 4,707 4,600 21,515 22,281 22,081 24,283 25,948 24.304 19,622 20,163 18,449 20,680 26,504 28,889 27,631 32,679 31,174 36,204 32,372 37,028 47,648 46,000 10.66 10.78 9.54 9.29 9.24 9.14 10.26 9.84 8.88 9.45 9.81 9.93 9.27 10.41 9.56 10.30 9.79 10.84 10.12 10.00 198 220 244 308 322 79 159 159 182 214 263 267 259 280 279 307 263 237 344 300 1,466 1,738 1,902 2,789 2,285 669 1,195 1,030 1,497 1,609 1,926 1,906 1,873 I 2,026 I 2,017 | 2,136 j 1,723 1 1,664 1 2,485 1,900 7.40 7.90 7.79 9.06 7.10 8.47 7.52 6.48 8.23 7.51 7.32 7.14 7.23 7.24 7.23 6.96 6.55 7.02 7.22 6.33 699 873 904 305,940 358,675 405,174 437.68 410.85 448.20 1 2 Footnotes at bottom of page 48. M 48 BRITISH COLUMBIA Table 2b.—Summary of the Number of B.C.H.I.S. In-patients (Including Extended Hospital Care Patients) and Short-stay Patients, 1949-68 Total Adults, Children, and Newborn In-patients Estimated Number of Emergency and Minor-surgery Patientsi Total Receiving Benefits 1949 1950 ... 1951 1952 ' 1953 1954 1955 174,269 178,979 184,326 189,871 208,530 229,735 242,034 253,001 257,398 274,694 290,650 303,608 311,261 314,963 323,079 327,796 333,762 346,242 357,538 374,201 29,000 44,502 47,656 46,767 52,582 63,621 70,553 76,375 83,530 91,883 100,292 107,312 121,000 128,000 135,000 141,000 160,000 175,000 195,000 210.000 203,269 223,481 231,9812 236,63® 261,112 293,356 312,5*7 19S6 329,376 1957 340,928 1958 1959 1960 1961 1967. 366,577 390,942 410,920 432,261 442,963 1963 1964 . 458,079 468,796 493 762 1965 1966 19672 ,- 19683 __ _ _ 521,242 552,538 584.701 Totals 5,475,937 7 079 07"! I 7.ssl;nio 1 Years 1962 to 1968 estimated, includes day-care surgery. 2 Amended as per final reports received from hospitals. s Estimated, based on hospital reports to October 31, 1968. Table 3.—Patients Separated, 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 19681 (Excluding Extended Care Hospitals). Bed Capacity Total 250 and Over 100 to 249 50 to 99 25 to 49 Under 25 Patients separated— Adults and children Newborn Patient-days— Adults and children Newborn Average days of stay— Adults and children..... Newborn... 328,433 30,841 3,099,840 222,867 9.44 7.23 143,424 12,273 1,521,915 95,718 10.61 7.80 83,854 8,660 714,445 60,105 8.52 6.94 56,224 6,672 517,125 46,037 9.20 6.90 35,258 2,593 269,570 16,546 7.65 6.38 9,673 643 76,785 4,461 7.93 6.94 1 Estimated, based on hospital reports to October 31, 1968. Footnotes to Table 2a i Amended as per final reports from hospitals. 2 Estimated, based on hospital reports to October 31, 1968. Estimated patient-days (including newborn 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; 1960, 1,804; 1961, 1,806; 1962, 1,841; 1963, 1,835; 1964, 1,815; 1965, 1,799; 1966, 1,779; 1967, 1,754; 1968, 1,771. (1954 and subsequent years are based on total population. Because the Armed Forces, Royal Canadian Mounted Police, and some other groups are not insured under the Provincial plan, the actual incidence of days would be somewhat higher than shown.) In addition, estimated patient-days per thousand population for extended care amounted to 184 in 1967 and 202 in 1968. Population figures are revised according to latest census figures. HOSPITAL INSURANCE SERVICE, 1968 M 49 Table 4.—Percentage Distribution of Patients Separated and Patient- days for B.C.H.I.S. Patients Only, in British Columbia Public Hospitals, Grouped According to Bed Capacity, Year 1968x (Excluding Extended Care Hospitals). Bed Capacity Total 250 and Over 100 to 249 50 to 99 25 to 49 Under 25 Patients separated— Adults and children Newborn Patient-days— Adults and children Per Cent 100.00 100.00 100.00 100.00 Per Cent 43.67 39.80 49.10 42.95 Per Cent 25.53 28.08 23.05 26.97 Per Cent 17.12 21.63 16.68 20.66 Per Cent 10.73 8.41 8.69 7.42 Per Cent 2.95 2.08 2.48 2.00 1 Estimated, based on hospital reports to October 31, 1968. CHARTS The statistical data shown in the following charts prepared by the Research Division are derived from Admission-Separation forms submitted to the British Columbia Hospital Insurance Service. The major diagnostic categories used for the table on pages 55 to 58 are more detailed than the diagnostic groups shown on the charts. Both lists are based on the International Classification of Diseases, Adapted, prepared by the Public Health Service of the United States Department of Health, Education, and Welfare. Readers who are interested in more detailed statistics of hospitalization in this Province may wish to refer to " Statistics of Hospital Cases Discharged during 1967 " and " Statistics of Hospitalized Accident Cases, 1967," available from the Research Division. M 50 BRITISH COLUMBIA r- ON 0, o Bi O H O z o < o y-i < m pi < w lb tt, 0 IX tt, Q ° Z z 5 o ~—' H « 2 H cn W O H Z w o rt w H rt u < HOSPITAL INSURANCE SERVICE, 1968 M 51 ON UJ < u tt, o cn < Q Q Z < UJ cn < CJ ►J < UJ < w Q Z < w 1-1 I tt, o z o H « 3 H w o < w O < H Z W U rt w PL, H rt < u I t— vo so >n ■* rf to m rS fS —i V3 uj < vvv i 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 - ^ i 1 ^ i i ^ - o 3* Is ■C o. ■:j — C S3 j 9 ft* U o Mo •So ats o 3 o& <u OJ — •a i- ca O _, u .a <s ~ i—^ u x> £■" i, Q-o -S -a s; i— rt X» e ^^ ■- HOSPITAL INSURANCE SERVICE, 1968 M 53 r- ON w o > Pi w tn < o z u tt, o w (* H 25 * cn IX < P < H I—I a, 8 X s< o z o H P 2 5 H cn o < z u rt w Ph H rt < S3 u < s UJ tt, < s u "3 rt g„n. y 1 ^ 3 1.A/ X) 5 i v u. r/i r- --/■ ii-— M 54 BRITISH COLUMBIA Chart V.—Average Length of Stay of Cases* in Hospitals in British Columbia, by Major Diagnostic Groups in Descending Order, 1967 (Excluding Newborns). Diseases of the circulatory system 1/^ Neoplasms Diseases of the bones and organs of movement Diseases of the blood and blood-forming organs Certain diseases of early infancy Diseases of the nervous system and sense organs Congenital malformations Mental, psychoneurotic, and personality disorders Allergic, endocrine system, metabolic, and nutritional diseases Infective and parasitic diseases Injuries and adverse effects PROVINCIAL AVERAGE LENGTH OF STAY Diseases of the digestive system Diseases of the skin and cellular tissue Diseases of the genito-urinary system Diseases of the respiratory system Deliveries and complications of pregnancy, childbirth, and the puerperium Symptoms, senility, and ill- defined conditions Supplementary classification for special admissions * Including rehabilitative care. wiiiii/ii/iiii/iiiiii/iiiiii/iii/i ■>■• iiiiiiiiiiiiiiiiiiiiiiiiiiinik 'iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii >« mimimmiiiiiiiiiiiiiiiii, Wllllllllllllllllllllllllllllli» W////////////////////////M MM////////////////////////. - llllllllllllllllllllllllllllllllll, WIIIIIIIIIIIIIIIIIIIIIIIIIi - '////////////a////////////, Wlllllllllllllllllllllllll ™ l/lllllllllllllllllll/ll/im W////////////////////M.... 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"i-viNrtTj*invC2^ooc>O^Nrt^«'riet~-QOO\0'-|'AtNrriTt invor~-ooO\Or—cs'icn'^-in Hn^MccirtHcnmn'it^^TtTtTtflTtTtTt^iniAflift^^ m<nin<nmvovovoP\ovovD > > > >< >< HOSPITAL INSURANCE SERVICE, 1968 M 57 cN©**in>—i.-ni^^DONOOi-HiriCN CO r— d Tf" CN ©' rH ©" © m" CN ri oi vo ov CN Ov r~ m oo rM d d d © rn rt in^tcNmcntNinooooov'—i©oo niNHMNOnoomHiHrt NOOK vo r- cn o © © CN CN rt ri d rt ©' rt it CN Tf m rt ©" ©' Tt rtOjOlDitOOi oo* vd cn vd cs cn 't ONt-nr-ovONr-TtONONmooinr-- cNcNO © in in oo m st cn m oo" Tf o\ r- ©" Tt od tt —. cs" cs' cn cn m" m* o ri cotO\so ^ pi rt in CS r~" cn m cs cn" od ** m* vd CN Tt n ri n (— © CN CN in ON On tt CN Ov vo cn n as vo © m ov >n oo vd Ovcnov-tcN'-iO'-iONcncNvoin TfcNONr-cntNONi—rt-rtr-tncn OvOcnoo©vocsmr-rtr---itN tN CN OO m m vo tN (N 00 oo r- r- vo VD 00 00 00 00 Ov ON rt t- tN Ov r- CN m rN On vd f- CN rn on VD 00 © Tf r- co r- •* vo co vo r- m cn ON OV OC Tf Tf CO SO VD 00 cn cn cn r-Cmvort cn m cn O Tt- t— On CN Tf m cs on — VO — rt vd On oo Tf oo Ov m t^ vo m CN © t- O m On © rt cn Ov o\ cn r-comcnvpTfocN ©©Tf Tf©©cn vovor-T-cN © '— vc Tt ONcomvoTfmcnoNTfo—iOOv mmoo ooooooTf r- Tr ov © vd Ht>ii*iO tno^c>©Qom'^inmcNvDTtrt ©©vd vd .> r- vo tNtNcnmcs vo vo ■* N m e- cn vf l> m in cn cn rn cn vo" Tf" Tt so so os in cN Tt cn cn" ■* -h in cn m \d vd cn r- on © „ — cn cn oo vO©mvD'—'TtvDVDvovo -"rttNcnrn „ , | cnVDVOVDvovOTfrtinO © I ririm't vo tN vo vo vo vd ON CN - . 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I s >, >, O ~ h Sh "h ht 0 0-3 0 « « o ™ QQU « - u ra ra g cj S3 u a i" tj T3 Si «<QO pj rt rt .2 "S x SEsSg 5 o 5! ra o b °.a a ss tr a I g a O a tu ra r-i o S w A f. i* n •x P Tl ra C cn _. c (3 a T3 ra M (B c o C a .s ct T G B > q et > "c t u o ra =3 c 3 '5 "tn X •a c a to e 'E tn 1 tu p § r3 s o c „-' rt CJ r- 8-2 3 o o P 5^ ft &w g rv J3 >rt rt <rt ° rt O O O CJ O 0) CJ 0) M *J „ H H 3^333 O i^ U CJ t. ra 3 ra ra ra U '3' Vh Ih Ih fc .5 Ph Ph rt „ a u ra rt •a c rt -E2 c O o 1 ■a c ra '5 c a T3 o. 1 c ra 0) ; E i tu 3 x> i rt : *f, OJ i rt 3 tj < 3 11 '? | r: sia <a ' OJ 0 ■a S 0 3 H 3 pq .,aa — CJ ^ G II rt O o S "ir cn ra 0 I b w *^ ■O >s a k 3 .3. =1 g OJ •a a o t_) jhtv QJ TT tu.-3| UodU00 WO0>S< > M 58 BRITISH COLUMBIA T3 3 •S s o g Z * o Br o z 3 rJ u X m r- Os m ui o o w H u H 8 z o < o hi r« n r, z o H < H < CO o a o (M 3 0 0 cs : © i cs © hO b,<1 ©" | © j © ©" ran © B 0 ■""' Q CU 60 rt cn d OJ m | © ; Tf © CJ <n ©' id id © t-t (J o o Ph .,<*-' o o on rt .5 rt ON [ 00 ! oo t> a> m-2 Tf i cn j Tt On > ec/a ' Tf ^3 OO 1 rt j p- I— o 0 VO i l> 1 Ov © rao Tt ! ri j CS in I> | | K in m 0 1 i tN cn OS Tf m in QJ © © cn cn m m CN a u m" cn cn c- Ov cs cs d vd" CO Z OS NNO0 7 o m m" *7 < ipcMCS A Q 1-* CN cN r* q ©"rt CN CN « J 1 £ u > a 60 .3 ■3 s cn C ■s 9 O a ft CJ u 3 o 2 00 8'3 §3 o" to 60 .9 •3 ra ■o 2 st 3 as rr TH 3 O 73 ■3 3 S -a CU C ra rt « tn C rt CU X) a M o rt rt a ra CJ I 3 2 co *3 3 £ £ o O rt 5 CO 3 rt W 3 « W rt cd tB c - 1 3 "S 'o F 5 w r JS ft £ E I •3 o rt h lias 8 •aSsSo Be . . . . 3 vn ^ rr oo CQ 9s 9s Os Os h-t I HOSPITAL INSURANCE SERVICE, 1968 M 59 STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR THE FISCAL YEAR ENDED MARCH 31, 1968 Administration— Salaries $717,689.00 Temporary assistance 4,445.00 $722,134.00 Office expense 50,184.00 Travelling expense 37,077.00 Office furniture and equipment 10,055.00 Printing and publications 1,539.00 Tabulating and rentals 2,365.00 Motor-vehicles and accessories 2,489.00 Incidentals and contingencies 1,075.00 Construction and consultation fees 29.00 Technical surveys 22,049.00 $848,996.00 Less transfer, Vote 128 (b)—Salary Adjustments 41,508.00 $807,488.00 Payments to hospitals 108,805,134.00 Grants in aid of construction 6,050,375.00 Total $115,662,997.00 Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1969 730-968-7473
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Twentieth Annual Report British Columbia Hospital Insurance Service JANUARY1 TO DECEMBER 31 1968 British Columbia. Legislative Assembly [1969]
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Title | Twentieth Annual Report British Columbia Hospital Insurance Service JANUARY1 TO DECEMBER 31 1968 |
Alternate Title | HOSPITAL INSURANCE SERVICE, 1968 |
Creator |
British Columbia. Legislative Assembly |
Publisher | Victoria, BC : Government Printer |
Date Issued | [1969] |
Genre |
Legislative proceedings |
Type |
Text |
FileFormat | application/pdf |
Language | English |
Identifier | J110.L5 S7 1969_V01_15_M1_M59 |
Collection |
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 | 2018-04-12 |
Provider | Vancouver : University of British Columbia Library |
Rights | Images provided for research and reference use only. For permission to publish, copy or otherwise distribute these images please contact the Legislative Library of British Columbia |
CatalogueRecord | http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1198198 |
DOI | 10.14288/1.0365653 |
AggregatedSourceRepository | CONTENTdm |
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