PROVINCE OF BRITISH COLUMBIA HOSPITAL INSURANCE ACT Nineteenth Annual Report British Columbia Hospital Insurance Service JANUARY 1 TO DECEMBER 31 1967 Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1968 Victoria, B.C., January 25, 1968. To Major-General the Honourable George Randolph Pearkes, V.C., P.C., C.B., D.S.O., M.C., CD., Lieutenant-Governor of the Province of British Columbia. May it please Your Honour: The undersigned has the honour to present the Nineteenth Annual Report of the British Columbia Hospital Insurance Service covering the calendar year 1967. WESLEY DREWETT BLACK, Minister of Health Services and Hospital Insurance. British Columbia Hospital Insurance Service, Victoria, B.C., January 25, 1968. The Honourable Wesley Drewett Black, Minister of Health Services and Hospital Insurance, Parliament Buildings, Victoria, B.C. Sir,—I have the honour to present herewith the Report of the British Columbia Hospital Insurance Service covering the calendar year 1967. D. M. COX, F.A.C.H.A., Deputy Minister of Hospital Insurance. DEPARTMENT OF HEALTH SERVICES AND HOSPITAL INSURANCE BRITISH COLUMBIA HOSPITAL INSURANCE SERVICE The Honourable Wesley D. Black Minister of Health Services and Hospital Insurance W. J. Lyle Assistant Deputy Minister D.M. Cox Deputy Minister of Hospital Insurance J. W. Mainguy Director of Hospital Consultation, Development, and Research Dr. C. F. Ballam Medical Consultant A. W. E. Pitkethley Manager, Hospital Construction and Planning Division K. G. Wiper Administrative Officer and Personnel Officer N. S. Wallace Manager, Hospital Finance Division 'J^.S m -JfV, J. Bainbridge Manager, Hospital Consultation and Inspection Division , S. Thomson Director, Research Division Dr. D. S. Adams Assistant Medical Consultant CONTENTS Page General Introduction 11 Regional Hospital Districts 12 British Columbia Regional Hospital Districts Financing Authority Act 13 The B.C.H.I.S. Planning Group 13 British Columbia General Hospitals (Comparisons of Growth) 14 The Hospital Insurance Act 16 The Hospital Act 16 Persons Entided to or Excluded from the Benefits under the Hospital Insurance Act 17 Entitled to Benefits 17 Excluded from Benefits 17 Hospital Benefits Available in British Columbia 18 In-patient Benefits 18 Emergency Services and Minor Surgery 18 Application for Hospital Insurance Benefits 18 The Hospital Rate Board and Methods of Payment to Hospitals 18 Organization and Administration 19 Assistant Deputy Minister 19 Hospital Finance Division 20 Hospital Accounting 21 Hospital Claims 21 Hospital Construction and Planning Division 23 Hospital Projects Completed during 1967 24 Hospital Projects under Construction at Year-end 26 Projects in Advanced Stages of Planning 27 Additional Projects Approved and in Various Planning Stages 27 Director of Hospital Consultation, Development, and Research 30 Hospital Consultation and Inspection Division 30 Research Division P 32 Medical Consultation Division 3 2 Administrative Officer 34 Eligibility Representatives' Section 35 Third Party Liability Section 35 General Office 35 Public Information 36 Approved Hospitals 37 Public Hospitals 37 Outpost Hospitals 38 Federal Hospitals 38 Private Hospitals (Providing General Hospital Services) 38 Rehabilitation, Chronic, and Convalescent Hospitals 38 Extended Care Hospitals 38 9 O 10 BRITISH COLUMBIA Page Statistical Data 38 Table 1a.—Patients Separated (Discharged or Died) and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public Hospitals Only, 1949-67 (Excluding Federal, Private, and Out-of-Province Hospitalization) (Including Rehabilitation Hospitals) 40 Table 1b.—Total Patient-days and Proportion Covered by the British Columbia Hospital Insurance Service, British Columbia Public Hospitals Only, 1949-67 (Excluding Federal, Private, and Out-of-Province Hospitalization) (Including Rehabilitation Hospitals) 41 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, 1949-67 (Including Rehabilitation Hospitals) 42 Table 2b.—Summary of the Number of B.C.H.I.S. In-patients (Including Rehabilitation Patients) and Short-stay Patients, 1949-67 43 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 1967 (Excluding Extended Care Hospitals) 43 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 1967 (Excluding Extended Care Hospitals) 44 Charts 44 I.—Percentage Distribution of Days of Care by Major Diagnostic Groups, 1966 45 II.—Percentage Age Distribution of Male and Female Hospital Cases and Days of Care, 1966 46 III.—Percentage Distribution of Hospital Cases by Type of Clinical Service, 1966 47 IV.—Percentage Distribution of Hospital Days by Type of Clinical Service, 1966 48 V.—Average Length of Stay of Cases in Hospitals in British Columbia by Major Diagnostic Groups, 1966 (Excluding Newborns) 49 Hospitalization by Major Diagnostic Categories, 1966 50 Statement of Receipts and Disbursements for the Fiscal Year Ended March 31, 1967 _-_ 54 L Nineteenth Annual Report of the British Columbia Hospital Insurance Service GENERAL INTRODUCTION Donald M. Cox, F.A.C.H.A., Deputy Minister of Hospital Insurance During the 19 years since the commencement of hospital insurance coverage in British Columbia, continuous and vital development has taken place in the provision of expanded hospital facilities and improved services throughout the Province. This progress in the hospital field has been the result of the combined efforts of government, hospitals, organizations, and individuals, whose contributions ensure that good and efficient hospital services are made available to the residents of the Province. During the past year, payments to hospitals were at their highest level since the inception of the Hospital Insurance Service, and the vast programme of hospital construction which has been evident throughout the length and breadth of the Province for more than a decade continued at an accelerated pace. It is estimated that in the current fiscal year $108,000,000 will be paid by the British Columbia Hospital Insurance Service to the hospitals of the Province toward hospital expenses incurred by residents. Daily payments to British Columbia hospitals have increased from $50,000 in 1949/50, the first complete fiscal year of coverage, to $296,000 in 1967/68. British Columbia's programme of hospital construction, initiated at the community level by public-minded citizens, and stimulated by the provision of generous financial assistance from the Provincial Government, has produced, since 1949, over 8,500 beds at a total cost in excess of $113,000,000. The Provincial Government has provided grants estimated at $53,600,000 toward the costs of construction. During 1967 new hospitals were opened at Duncan, Comox, and Summerland; additions and renovations were completed at Haney, Kamloops, Nanaimo, North Vancouver, Prince George, Murrayville, New Westminster (St. Mary's), and Queen Charlotte City; an intensive-care ward and heart catheterization laboratory were completed at the Vancouver General Hospital; and a new boiler plant was constructed for the Royal Jubilee Hospital in Victoria. These projects involved a total of 665 beds, and construction costs were approximately $12,000,000. As the year drew to a close, some 790 beds were under construction throughout the Province and over 2,100 beds were in the advanced stages of planning. The most noteworthy item of progress in the British Columbia Hospital Insurance Service for the year was the establishment of regional hospital districts for financing hospital construction. The Regional Hospital Districts Act and the Regional Hospital Districts Financing Authority Act were passed by the Legislature in March, 1967 (for details see pages 12 and 13). The Province has been divided into regional hospital district areas, and the majority of those areas have been incorporated into regional hospital districts by Letters Patent. In the Fraser-Burrard Regional Hospital District, the largest district from standpoints of population and numbers of hospitals, the ratepayers approved a $51,- 000,000 by-law on October 4, 1967, by an overwhelming majority to provide funds for 16 hospitals. 11 O 12 BRITISH COLUMBIA By the year-end, Government approval had been given for money votes in seven other regional hospital districts for hospital projects involving a total cost of approximately $31,000,000. During the year the Hospital Insurance Service continued to receive the advice and guidance of the medical profession, for which we were most appreciative. I should like to again record my appreciation of the assistance rendered by the Canadian Medical Association (British Columbia Division), the College of Physicians and Surgeons, and by the medical profession generally. The work of the Laboratory and Radiological Advisory Councils was once again of inestimable value in assisting hospitals to improve their 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 Liaison Committee with the British Columbia Hospitals' Association has proven very worth while, and several constructive items resulted from meetings held during the year. As in previous years, members of our senior staff were invited to attend the Hospitals' Association's annual conference, held in Penticton in October. We are always grateful for the opportunity the conference presents to meet with representatives of boards of management, administration, and the nursing service from hospitals throughout the Province. The association marked its 50th anniversary in 1967, and in honour of the occasion the Honourable Wesley D. Black, Minister of Health Services and Hospital Insurance, presented the British Columbia Hospitals' Association with an illuminated scroll " in appreciation of the outstanding services rendered to the hospitals of the Province." Reports submitted by the various divisions which comprise the administrative structure of our Branch appear under " Organization and Administration," commencing on page 19 of this Report. 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 23 of these were incorporated as regional hospital districts during 1967. 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 page 13) 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 their 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 the remainder of the annual amortization cost required to retire its debentures which are held by the Authority. HOSPITAL INSURANCE SERVICE, 1967 O 13 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 will be 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 applied up to this time. BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS FINANCING AUTHORITY ACT This new 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, review 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. 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 33 meetings during the year. Six of the meetings were with delegations from hospitals about the future needs and long-range planning problems of those hospitals. Individual members on the Planning Group have acted as liaison members between the Service and several local hospital planning groups. During the year the group considered seven new reports compiled by the Research Division on area needs, and in addition reviewed extensions of nine reports previously prepared which were brought up to date by the Research Division with new projects for the future. (Continued on page 16.) O 14 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) 105 100 SO 85 80 70 65 60 50 45 J 40 Is5 30 25 20 15 1957 1967 (est.) Total Full-time Staff and Average Number of Patients (Adults and Children) per Day 14 ^«& s 11 ■8 10 c a _> 9 9 ft 8 TTEKTS CA^5 , VV.TH P^Y 6 ^^n^1j 5 4 1966 1967 (est.) HOSPITAL INSURANCE SERVICE, 1967 Gross Salaries and Wages and Other Operating Expenses O 15 70 65 ^v"' a 0 2 30 .Vs 5$0 >^ 25 G1 cS bt _^ 20 15 4S» ^^^ ,o^*- 5 '''Including approximately 53,500,000 in staff fringe benefits 1967 (est.) Hospitals' Growth Rate (Public General Hospitals, Excluding Federal and Contract Hospitals, Etc.) 1948 1967 (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 $107,500,000 18,000 3,100,000 1,947,000 572 177 110 O 16 BRITISH COLUMBIA Following recommendations by the Planning Group, hospitals were given approval to undertake preliminary planning of over 800 beds. High priority was given to recommendations for the development of extended hospital care beds. The approvals for planning are in addition to those outstanding in the previous year. Apart from consideration of specific hospital units, the group also concerned itself with other subjects of importance to hospital planning in the Province. Some of these were the new regional hospital districts and their implications; hospital and other services for children, including those for the physically handicapped, for the mentally ill, and those needing extended care; out-patient and day-care services; rehabilitation and activation services in hospitals; and staff residences, as well as subjects related to the flexible development of hospital structures to meet changes in patterns of care. 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. (3) The wide range of in-patient benefits and the emergency out-patient and minor surgery 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. HOSPITAL INSURANCE SERVICE, 1967 O 17 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. 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 (/) 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. O 18 BRITISH COLUMBIA 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 anesthetic 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 and Minor Surgery 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. 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. 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 patient's 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. HOSPITAL INSURANCE SERVICE, 1967 O 19 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 95 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. The following reports provide a brief outline of the work carried out during 1967 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 18), Vice-Chairman of the Hospital Planning Group (see page 13), 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 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. L O 20 BRITISH COLUMBIA 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 will be responsible for reviewing the annual budgets prepared by each regional hospital district as required by the legislation, and will work closely with the Hospital Financing Authority and the regional hospital districts in the financing of hospital capital projects and repayment of debentures. The Finance Division is also responsible for the approval of grants to assist hospitals in the purchase of equipment. In 1967, after a review of approximately 4,500 applications received from hospitals, grants of approximately $1,400,000 were approved on movable and fixed technical equipment costing $4,000,000. As a means of assisting hospital employees to maintain high working standards, the Hospital Insurance Service provided $80,000 during the year to enable 750 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). 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 INSURANCE SERVICE, 1967 O 21 Hospital Accounting A. D. MacKenzie, C.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 additional to that previously done by this section, as a result of passage of the Regional Hospital Districts Act at the 1967 sitting of the Legislature. In carrying out the inspection duties in 1967, 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 1967 amounted to $110,000,000. 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. During 1967, construction projects involving expenditure of $10,300,000 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. 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. 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 by the Section to hospitals in the proper method of submitting the individual accounts, which is accomplished by correspondence, telephone, and personal visits. During the year the supervisor visited hospitals in the Prince Rupert area, Okanagan, Vancouver, and Victoria, attending conferences at Terrace and Penticton. Co-ordination of amendments to the Admission-Separation Record (H.I.A. 18) was undertaken with the form being redesigned to include certain new statistical information required by the Medical Consultant and Research Divisions. The new forms will be used commencing January 1, 1968. O 22 BRITISH COLUMBIA The filing, accounting, and review of the quarterly billing for extended care hospital patients has increased in complexity and volume as new units are 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. Research and adjustments to accounts, due primarily to changes of responsibility, also showed an increase in volume. Accounts from all sources were in excess of 1,500 accounts per working-day for in-patients, and over 800 emergency-service or minor-surgery account forms were handled per working-day. Discussions with the Bureau of Statistics continued regarding the efficient use of the I.B.M. electronic data-processing equipment. These included discussions on the redesigning of the key-punch card in relation to the new requirements for statistics, which will be reflected in the revised application form. 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 5,000 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. 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 600 queries per month on such accounting matters were addressed to British Columbia hospitals. Preliminary figures for 1967 show that more than 370,000 accounts (excluding out of Province) were processed. For comparison the figures for 1966 were 357,221 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 35,000 hospital accounts incurred by welfare recipients were checked to this file to determine eligibility for hospital benefits. 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. 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 1967 over 4,700 accounts, amounting to an estimated $1,173,100, were paid on behalf of qualified residents who were hospitalized in the other Provinces and Territories of Canada, and the HOSPITAL INSURANCE SERVICE, 1967 O 23 continental United States, including Alaska and Hawaii; Austria, Australia, Belgium, British West Indies, Cape of Good Hope, Central America, China, England, France, Greece, Holland, Hong Kong, Ireland, Italy, Jamaica, Japan, Mexico, New Zealand, Norway, Scotland, South America, Spain, Sweden, Switzerland, Tahiti, Thailand, West Germany, and Yugoslavia. This office also compiles up-to-date hospital rate schedules for every approved hospital in Canada. Plans to commence, in January, 1968, a punch-card record of statistics from out-of-Province accounts were completed, including the designing of a new form and the procedures required to carry out this work. The Filing and Mail Unit sorted and filed over 5,000 documents and letters daily, an increase of 400 over last year. The filing system was expanded and new procedures instituted, in order to accommodate the quarterly billings for the extended care hospitals. New methods of routing the documents within the section were required to accommodate some of the extra flow of work. Hospital Construction and Planning Division A. W. E. Pitkethley, Manager The main functions of this Division can be briefly described as follows:— (1) Providing hospital boards of management, their architects and planning committees, with a consultative service in the planning of hospital construction projects, including new hospital facilities and additions to and renovations of existing hospitals. 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 consulting engineers with basic planning criteria for the logical development of plans. (2) Provincial grants-in-aid toward construction, renovations, and building improvements are processed and recommended for payment by this Division. The Division also initiates applications for Federal construction grants, and processes and submits claims for payment. During 1967, 25 applications for approval of Federal construction grants toward major construction and renovation projects were prepared and submitted. The Manager of the Division is a member of the B.C.H.I.S. Planning Group, which has the responsibility of reviewing and making recommendations to the Deputy Minister on matters concerning the development of hospital facilities throughout the Province (seepage 13). A great deal of time is spent by the Division in reviewing plans of proposed building projects. Special attention is given to the interrelationship of the various departments of the hospital building to ensure a layout arrangement that can provide a high standard of patient-care, efficient and economical operation, and adequate service and clinical facilities. In planning hospital facilities, attention is also given to the need and method of future expansion in conjunction with the logical and best use of the hospital-site. Proposed hospital-sites are approved by this Division, and direction and guidance are given in site selection. Wherever possible, potential sites are inspected by a member of the Division. During the year approximately 200 sets of plans were received by the Division. These drawings covered many phases of planning, including small-scale schematic drawings, preliminary sketch drawings, large-scale detail drawings, and final working drawings and specifications, including the architectural, mechanical, electrical, and plumbing drawings. O 24 BRITISH COLUMBIA 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 the designs for mechanical systems for new hospital buildings that reflect this approach include heat recovery systems, air recirculation and zoned heating ventilating controls, and limited air-conditioning systems. Consideration was directed toward the cooling by natural means, such as well, river, or lake water, for air-conditioning systems. Continuing benefit was derived through the co-operation of the Public Works Department by assigning two architects to this Division. Detailed reviews of hospital plans were made, involving some 30 hospital projects through various stages of planning. Liaison was also 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. Both members of the architectural profession working for the Division are members of the Hospital Committee and attend meetings on a regular basis. The provision of a complete consultative planning service to hospital boards and their planning committees is made possible through the co-operation of Health Branch personnel, members of the medical and nursing professions, and the various 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, the Technical Supervisor of Radiology, and the Provincial public health officers. The Division also maintains liaison with the Canadian Medical Association (British Columbia Division) and with the Faculty of Medicine of the University of British Columbia. Proposed layouts for physical medicine departments were reviewed by the Director, School of Rehabilitation Medicine, Faculty of Medicine, University of British Columbia. Through the co-operation of the Provincial Department of Labour, the office of the Inspector of Factories provides a consultative service to the British Columbia Hospital Insurance Service on proposals for elevators and dumb-waiter installations in hospitals. During 1967 the Manager of the Division, as well as the architects and engineer attached to his staff, made a number of visits to hospitals to achieve on-site evaluation of problems relating to planning projects, and also to inspect projects which had been completed. On June 8th and 9th the Manager of the Division attended a course in " Hospital Hygiene and Infection Control " at the Faculty of Medicine, University of British Columbia, and gave a talk on " Operating Room Planning." On September 18th and 19th the Manager also attended a " Symposium on the Control of Hazards in Hospitals," under the joint sponsorship of the National Research Council and Department of National Health and Welfare, Ottawa. (a) Hospital Projects Completed during 1967 Summerland General Hospital, Summerland.—The Honourable W. A. C. Bennett opened the new Summerland hospital on June 17, 1967. The new hospital is a single-story reinforced-concrete building with accommodation for 28 acute-care beds. St. Joseph's General Hospital, Comox.—The Honourable Dan Campbell, Acting Minister of Health Services and Hospital Insurance at the time, opened the new addition to the Comox hospital on June 17, 1967. The new wing is a three-story HOSPITAL INSURANCE SERVICE, 1967 O 25 reinforced-concrete building containing 74 beds. The third story is in " shell " form and will provide approximately 54 additional beds when required. Cowichan District Hospital, Duncan.—On September 15, 1967, the Honourable Wesley Black, Minister of Health Services and Hospital Insurance, opened the Cowichan District Hospital, which replaces the King's Daughters' Hospital. The new hospital has 127 finished beds, semi-finished areas for a further 19 beds, and a fourth floor in " shell" form which could provide an additional 40 beds in the future. For the first time since commencement of the British Columbia Hospital Insurance Service, the financing of the local area's share of hospital construction involved the participation of four separate districts (City of Duncan, Municipality of North Cowichan, and Lake Cowichan and Koksilah Valley Hospital Improvement Districts). Maple Ridge Hospital, Haney.—A third floor containing 50 beds and new emergency, physical medicine, and laboratory departments at the ground-floor level were opened on September 9, 1967, by the Honourable Wesley Black. The Haney hospital now has a total capacity of 106 beds. Royal Inland Hospital, Kamloops.—Renovations and alterations to older sections of the hospital to improve service departments and to provide new rehabilitation, psychiatric, and intensive-care units were completed in the fall of the year. Langley Memorial Hospital, Murrayville.—Space for 10 acute beds previously left in a semi-finished condition was completed and brought into operation. Nanaimo Regional General Hospital, Nanaimo.—During the latter part of the year, the sixth floor of the hospital (previously unfinished) was completed to provide 37 additional acute beds. Saint Mary's Hospital, New Westminster.—The Honourable Grace McCarthy opened the new additions to this hospital on October 28, 1967. The expansion programme included 85 additional beds, a new physiotherapy department, an enlarged kitchen and cafeteria, and alterations to admitting, medical records, and administrative areas. Lions Gate Hospital, North Vancouver.—Further expansion of the new hospital building was completed during the year by the completion of the sixth and seventh floors for 138 additional acute beds. Alterations to the fourth floor of the older hospital building provided a further 21 psychiatric beds. In addition, certain renovations to the kitchen and central supply room in the new hospital were carried out and an additional operating-room finished. Prince George Regional Hospital, Prince George.—A 24-bed addition to the nurses' residence was completed at this hospital early in December. Queen Charlotte Islands General Hospital, Queen Charlotte City.—An addition for 7 pediatric beds was brought into service at this hospital early in the year. This addition, together with renovations to the former pediatric ward, resulted in a net gain of 6 beds. Vancouver General Hospital, Vancouver.—Three projects were completed during the year to provide an intensive-care unit, heart catheterization and electroencephalograph laboratories, and an in-service education area. St. Vincent's Hospital, Vancouver.—An underground steam-line to carry steam from Shaughnessy Hospital to St. Vincent's Hospital was completed in the fall. Royal Jubilee Hospital, Victoria.—A project to add to the boiler-house, and the installation of two new boilers, was completed at the Royal Jubilee Hospital during the year. The additional boiler capacity will serve not only this hospital, but the Veterans' Hospital and the Lee Avenue mental health facility also. O 26 BRITISH COLUMBIA (b) Hospital Projects under Construction at Year-end Campbell River and District General Hospital, Campbell River.—Addition for an extended-care unit of 25 unfinished beds, with provision for a further 12 beds. Castlegar and District Hospital, Castlegar.—Addition of a further story to the existing hospital to provide 50 beds and renovations to existing building for expanded service departments. Cranbrook and District Hospital, Cranbrook.—Construction of new hospital of 75 acute beds, plus 15 to be left unfinished initially, and construction of a 34-bed extended-care unit. Enderby and District Memorial Hospital, Enderby.—Addition and renovations to hospital to provide a net gain of 3 beds. Kelowna General Hospital, Kelowna.—Major addition to provide a total of 228 acute beds and enlarged service departments. Langley Memorial Hospital, Murrayville.—Conversion of old hospital building to provide 40 extended-care and 10 activation beds. Pouce Coupe.—Addition for an extended-care unit of 26 beds, enlarged dietary department, etc. Powell River General Hospital, Powell River.—Addition to the hospital to provide 26 extended-care beds, unfinished space for a further 8 beds, and enlarged emergency and dietary departments. Prince George Regional Hospital, Prince George.—Services expansion project which consists of an addition and renovations to provide enlarged laboratory, radiological, and emergency departments, etc. Mills Memorial Hospital, Terrace.—Construction of a wing to provide a net gain of 21 beds, and new emergency and physiotherapy departments, plus renovations for enlarged radiology and laboratory departments. British Columbia Cancer Institute, Vancouver.—An addition to the building to provide increased radiotherapy facilities. Canadian Red Cross Society, British Columbia-Yukon Division, Vancouver.— New facilities for its blood transfusion service. Health Sciences Centre, University of British Columbia, Vancouver.—Psychiatric unit to provide 60 psychiatric beds (Stage I), neurological research and teaching facilities (Stage II). St. Paul's Hospital, Vancouver.—A major renovation programme has been continued throughout the year. Renovations to service areas on the main basement floors were mostly completed, and also the centralization of the dietary facilities. Work is also under way to renovate four of the hospital's elevators. Jewish Home for the Aged, Vancouver.—A 60-bed extended-care unit is being constructed in conjunction with a boarding home. Certain facilities such as the lounge and service departments will be shared between the two units. Vancouver General Hospital.—Alterations for renal failure unit of 12 beds. St. Joseph's Hospital, Victoria.—Alterations to X-ray department. Royal Jubilee Hospital, Victoria.—Coronary care unit of 4 beds. Vernon Jubilee Hospital, Vernon.—An addition to the hospital to provide an extended-care unit of 60 beds and 27 more acute beds. Peace Arch District Hospital, White Rock.—Construction of a new 106-bed acute-care hospital adjacent to the existing building, plus 2 unfinished beds and a fifth floor in " shell " form which can provide 42 beds in the future. The existing hospital will shordy be renovated for a 42-bed extended-care unit. In addition, at the year-end, tenders had been received and a contract award was being considered for the following:— HOSPITAL INSURANCE SERVICE, 1967 O 27 St. Joseph's General Hospital, Comox.—Renovations and additions to the 1938 wing to provide 45 extended-care beds. Creston Valley Hospital.—Additions and alterations to provide a total of 44 acute-care beds. (c) Projects in Advanced Stages of Planning Matsqui-Sumas-Abbotsford General Hospital, Abbotsford.—Expansion and renovations. Burnaby General Hospital, Burnaby.—Expansion and renovations programme. Burns Lake and District Hospital, Burns Lake.—Additions and renovations. Chilliwack General Hospital, Chilliwack.—Additions and renovations. Providence Hospital, Fort St. James.—New facility. Windermere District Hospital, Invermere.—Additions and renovations. Nanaimo Regional General Hospital, Nanaimo.—Additions and renovations. Royal Columbian Hospital, New Westminster.—Up-grading existing services. Penticton Hospital, Penticton.—Expansion, renovations, and extended-care unit. West Coast General Hospital, Port Alberni.—Completion of space plus renovations and additions. Prince Rupert General Hospital, Prince Rupert.—Replacement. Princeton General Hospital, Princeton.—Replacement. Queen Victoria Hospital, Revelstoke.—Replacement. Surrey Memorial Hospital, North Surrey.—Addition and renovations. Trail-Tadanac Hospital, Trail.—Extended-care unit, regional laboratory, addition for psychiatric beds, plus renovations. G. F. Strong Rehabilitation Centre, Vancouver.—Addition and renovations. Health Sciences Centre, University of British Columbia, Vancouver.—New hospital facility (Stage III). St. Vincent's Hospital, Vancouver.—Additions and renovations. St. John Hospital, Vanderhoof.—Replacement. Royal Jubilee Hospital, Victoria.—Renovations and laboratory expansion. (d) Additional Projects Approved and in Various Planning Stages in 1967 Lady Minto Hospital, Ashcroft.—Replacement. R. W. Large Memorial Hospital, Bella Bella.—Replacement. Campbell River and District General Hospital, Campbell River.—Expansion for acute care. Chetwynd and District Hospital, Chetwynd.—New facility. St. Joseph General Hospital, Dawson Creek.—Expansion of services. Cowichan District Hospital, Duncan.—Extended-care unit. Providence Hospital, Fort St. John.—Completion of 15 acute beds. Golden and District General Hospital.—Expansion programme. Boundary Hospital, Grand Forks.—Completion of 5 beds. Wrinch Memorial Hospital, Hazelton.—Replacement. Fraser Canyon Hospital, Hope.—Expansion and renovations. Royal Inland Hospital, Kamloops.—Expansion, including extended-care unit. Victorian Hospital, Kaslo.—Replacement. Lillooet District Hospital, Lillooet.—Expansion and renovations. Arrow Lakes Hospital, Nakusp.—New hospital to replace existing hospital at Nakusp and New Denver. Royal Columbian Hospital, New Westminster.—Additions. Major Hospital Projects Completed or under Construction during 1967 COMPLETED Duncan, Comox, Summerland, Haney, Prince George, Queen Charlotte City, North Vancouver, Victoria (Royal lubilee), Vancouver (Vancouver General), Murrayville, Nanaimo, New Westminster (St. Mary's), and Kamloops. UNDER CONSTRUCTION White Rock, Vernon, Cranbrook, Campbell River, Enderby, Castlegar, Terrace, Pouce Coupe, Kelowna, Powell River, Prince George, Pouce Coupe, Murrayville, Victoria, Vancouver, White Rock, Comox, and Creston. (For details see pages 24 to 26.) New Westminster (St. Mary's) Addition ii *f t'~ '■ (Design consultants: Allen C. Smith & Associates, Vancouver.) ■ ■ ■ ■ ... Vancouver (U.B.C. Health Sciences Centre) . :::::::: :;:::;;; (Architects: Thompson, Berwick, Pratt & Partners, Vancouver.) Psychiatric Unit, Stages 1 and 2. Cranbrook "•••_w •.:.!> lejohn & Gower, Penticton.) (Architect: David P. Fairbank.) O 30 BRITISH COLUMBIA Lions Gate Hospital, North Vancouver.—Expansion of services and extended- care unit. Ocean Falls General Hospital, Ocean Falls.—Replacement. St. Martin's Hospital, Oliver.—Replacement. Prince George Regional Hospital, Prince George.—Expansion programme. Richmond General Hospital, Richmond.—Extended-care unit. St. Mary's Hospital, Sechelt.—Expansion programme, including extended-care unit. Shuswap Lake General Hospital, Salmon Arm.—Expansion. Bulkley Valley District Hospital, Smithers.—Addition. Squamish General Hospital, Squamish.—Renovations and improvements. Children's Hospital, Vancouver.—Replacement. Holy Family Hospital, Vancouver.—Activation unit and renovation of existing building for extended care. Mount St. Joseph's Hospital, Vancouver.—New acute unit and renovation of existing hospital for extended care. St. Paul's Hospital, Vancouver.—Renovation and expansion programme. Vancouver General Hospital, Vancouver.—Replacements and additions, including extended-care unit. Royal Jubilee Hospital, Victoria.—Renovations. St. Joseph's Hospital, Victoria.—Expansion programme. Priory Hospital, Victoria.—Extended-care unit. 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 Hospital 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 13 and 18 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 Victoria District Hospital Planning Board. The Director served on the Mental Health Committee which was appointed by the Minister in March to study the mental health services of the Province, and to make recommendations to the Minister respecting reorganization and future development of these services. 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 HOSPITAL INSURANCE SERVICE, 1967 O 31 private hospitals regardless of the type of care given. Its staff is composed of administrative, nursing, and dietary consultants. One of the administrative consultants now on staff is a specialist in management engineering. 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 Rate Board. Its members represent the Service on the Laboratory Advisory Council; Hospital Disaster Plan Review Committee; Welfare Institutions Board; British Columbia Council of Practical Nurses; Council of Hospitals with Schools of Nursing; Advisory Committee, Nurse Training Programme, British Columbia Institute of Technology; Practical Nursing Advisory Committee; British Columbia Nutritional Co-ordinating Committee; Food Services Technicians Advisory Committee, Vancouver City College; committees of the Registered Nurses' Association of British Columbia and the British Columbia Hospitals' Association, and the Health Sciences Centre, University of British Columbia. They also carry out liaison duties with the Health Branch, Mental Health Branch, Emergency Health Services, Civil Defence Organization, and other departments and offices of Provincial and municipal government. An active programme during 1967 resulted in 61 staff visits to acute, rehabilitation, chronic, convalescent, and extended care hospitals, and 161 staff visits to private hospitals giving nursing-home type care. The majority of these visits were made by individual consultants of this Division, the remainder by teams consisting of two consultants (25 visits) or three consultants (nine visits). Every private hospital in the Province giving nursing-home type care was visited at least once during the year by the nursing consultants. One hundred and thirty-five requests from acute hospitals for assistance in the placement of patients in lower-care facilities were processed during the year. Personnel of the Division attended many educational sessions during the year, as a necessary means of keeping abreast of changing concepts and techniques in the hospital field. Papers were presented by staff members at the Canadian Hospital Association Nursing Unit Administration Course, Vancouver; Victoria Chapter of Practical Nurses' Association meeting, Victoria; Executive Housekeepers Institute, Victoria; Nutritional Clinical Session, Victoria; and North Shore Medical Society meeting, Vancouver. Studies were also conducted into the following aspects of hospital planning and management: Preferred type of hospital bed; ratio of self-care beds to other beds; hospital ward size and patient toilet facilities; determination of the number of operating-rooms required; private-hospital operating costs; programme for development or reconstruction of small hospitals; management of therapeutic diets (in co-operation with the committee of dieticians from Victoria, B.C.); infant formulary cost study (in co-operation with the Dietary Consultant, Department of National Health and Welfare and Richmond General Hospital); nutrient analysis of menus in private hospitals; hot- and cold-food service carts; use of bulk frozen foods for hospital food service; recommended nursing procedures for controlling the spread of communicable diseases; recommended nursing organization and staffing for extended- care facilities; and projected need for nursing services by 1985. Several staff changes took place during 1967. In August Mr. C. C. White, administrative consultant, left the Service to become Assistant Administrator, St. O 32 BRITISH COLUMBIA Vincent's Hospital, Vancouver, and was replaced in September by Mr. P. M. Breel, from Ingersoll Hospital, Ont. Mr. J. P. B. Langran joined the staff in November as a management study consultant. Research Division D. S. Thomson, B.A., Director The Research Division is responsible for compiling and maintaining statistical data relating to hospitalization and morbidity within the Province. Most of the statistical information is derived from the Admission-Separation Records submitted by the hospitals for each in-patient. The data used are key-punched 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. The data are essential to the bed requirement studies carried out by the Division. In addition to a comprehensive analysis of hospitalization data, these studies also involve economic and population growth projections. School districts form convenient planning areas for most bed need studies, and consequently the Division prepares population estimates each year, broken down by age-group, sex, and race for each of the more than 80 school districts in the Province. The regional hospital districts are composed of groups of school districts, and consequently projections can readily be applied to these new areas. In attempting to assess hospital bed requirements more carefully, the Division carries out special studies. With the co-operation of Surrey Memorial Hospital, a comparison of maternity-ward occupancy was made with that predicted by a Poisson Distribution technique. At the year-end a study of waiting lists was being made, using the records of a number of co-operating hospitals. The Division also prepares for publication a number of annual bulletins, the most important of these being the " Statistics of Hospital Cases Discharged in 1966." This bulletin contains the 10 standard morbidity tables prepared by each Province as recommended by the Federal Advisory Committee on Hospital Insurance and Diagnostic Services, as well as an analysis of hospitalization in the Province of British Columbia by race, age, geographical location, major diagnostic group, and type of service. The bulletin also presents, in graphical form, trends in hospitalization over the past 10 years. "Statistics of Hospitalized Accident Cases" is another annual bulletin produced by the Division. This bulletin analyses in detail hospitalized accidents by circumstance, type of accident, and nature of injury. For the past few years this Division has been preparing statistical tables analysing patient-flow patterns in the metropolitan Vancouver area. As a planning aid to the new regional hospital districts, five such reports were prepared in 1967 covering the larger regional hospital districts, including that of Fraser-Burrard. There is a growing demand for morbidity data from research groups both inside and outside of government, and every attempt is made to provide information for worth-while projects. Mr. W. Selwood, B.A., joined the staff in February, 1967, as a research officer, filling a vacancy created by the resignation of Mrs. H. Thornton. 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 HOSPITAL INSURANCE SERVICE, 1967 O 33 " 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. 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. Consultative services by the Chief Supervisor of Medical Coders included visits to 23 hospitals during the year, with particular reference to medical records. In the capacity of consultant to hospital medical record departments, problems are identified and assistance and advice offered, so that medical records generally, in all British Columbia hospitals, will be of high quality and thereby contribute toward better patient-care and more satisfactory statistical information for continuing research studies. 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, and these studies have been greatly benefited by the recent legislation which makes 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. Dr. D. G. Adams, Assistant Medical Consultant, has assumed major administrative supervisory responsibility for the Coding Division and 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- to-day 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. 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, the Advisory Sub-committee for Chronic Renal Failure, and representation to special committees on training of paramedical personnel continued during the year. 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 O 34 BRITISH COLUMBIA staff of the hospital, the Medical Consultant is able, with the assistance of the Hospital Consultation and Inspection 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 relate 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 Welfare Branch 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 to ensure 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 1967 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. HOSPITAL INSURANCE SERVICE, 1967 O 35 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 B.C.H.I.S. 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 Internal accounting and supervision of expenditure continued as the main functions of this office. In summary, these responsibilities consist of maintaining personnel and payroll records, preparation of financial statements, administrative accounting, and purchasing. Departmental estimates were prepared as usual in consultation with Division Managers. Continuing assistance to the Hospital Construction and Planning Division was provided in connection with processing grants toward hospital alterations and renovations. O 36 BRITISH COLUMBIA The functions of Departmental Safety Officer were also carried out by the Supervisor of the General Office. Since the publication of the last Annual Report, this Department has won a gold and a bronze-on-gold award from the British Columbia Safety Council for 637,000 accident-free man-hours of operation. The bronze-on-gold award was presented to the Department by the Prime Minister, the Honourable W. A. C. Bennett, in December. The Departmental Safety Committee once again prepared safe-driving posters for use over the Christmas season by the Accident Prevention Division and by the British Columbia Safety Council. The Committee is also producing a safety news magazine which is now gaining wide acceptance in the Government Service. Public Information R. H. Thompson This office is responsible for carrying out the public information activities, in which there are three main areas of responsibility—the general public, approved hospitals, and in-service duties. The following is a summary of the work undertaken during 1967. A general outline of the organization of the Service, prepared at the request of the British Columbia Hospitals' Association, was completed, and 1,000 copies were supplied to the association for incorporating in its newly developed trustees' manual. A pamphlet containing statistical data and other information of interest to the administrative personnel of hospitals was prepared for distribution to delegates attending the British Columbia Hospitals' Association annual conference, held in Penticton in October. The " General Information " pamphlet was revised and reprinted, and copies were distributed to business and industry, civic organizations, Government Agents, welcome-wagon agencies, hospitals, and other services which come in regular contact with new residents of the Province. Several replacement pages were prepared for the B.C.H.I.S. Manual on Policy, Organization and Procedures, copies of which are held by all approved British Columbia hospitals. At the year-end a revised Index and Appendix of Hospital Lists was being developed. Press releases were issued to the various news media, dealing primarily with the official openings of new hospitals and other aspects of the Province's vast programme of hospital construction. Regular editions of the B.C.H.I.S. Bulletin were published during the year for distribution to all public hospitals and nursing homes. The Bulletin is an administrative aid used to clarify policy and procedural changes. Films in the B.C.H.I.S. motion-picture library, maintained for the free use of hospitals for in-service training purposes, were used quite extensively throughout the year and were seen by an estimated 1,500 hospital staff members. Assistance was given in up-dating the Departmental exhibit in the British Columbia Building on the grounds of the Pacific National Exhibition. Government exhibits are open to the public throughout the year and are viewed by thousands of visitors. Other duties included the summarizing of reports for the information of the Deputy Minister, maintaining the newspaper and hospital photograph files, replying to general correspondence, writing articles for publication, drafting speech material, and the preparation and editing of the Nineteenth Annual Report. HOSPITAL INSURANCE SERVICE, 1967 O 37 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. 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. King's Daughters' Hospital, Duncan. Kitimat General Hospital, Kitimat. Kootenay Lake General Hospital, Nelson. Lady Minto Hospital, Ashcroft. Lady Minto Gulf Islands Hospital, Ganges. Ladysmith and District General Hospital, Ladysmith. Langley Memorial Hospital, Murrayville. Lillooet District Hospital, Lillooet. Lions Gate Hospital, North Vancouver. McBride and District Hospital, McBride. Maple Ridge Hospital, Haney. Mater Misericordias 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's 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. O 38 BRITISH COLUMBIA Outpost Hospitals Red Cross Outpost Nursing Station, Alexis Red Cross Outpost Nursing Station, Edge- Creek, wood. Red Cross Outpost Nursing Station, Atlin. Red Cross Outpost Nursing Station, Kyuquot. Red Cross Outpost Nursing Station, Bam- Red Cross Outpost Nursing Station, Masset. field. Red Cross Outpost Nursing Station, Wad- Red Cross Outpost Nursing Station, Blue hams. River. Federal Hospitals Veterans' Hospital, Victoria. Miller Bay Indian Hospital, Prince Rupert. Shaughnessy Hospital, Vancouver. R.C.A.F. Station Hospital, Holberg. Coqualeetza Indian Hospital, Sardis. 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 G. F. Strong Rehabilitation Centre, Vancou- Queen Alexandra Solarium for Crippled ver. Children, Victoria. The Gorge Road Hospital, Victoria. Shaughnessy Hospital, Vancouver. Holy Family Hospital, Vancouver. Sunny Hill Hospital for Children, Vancou- Pearson Hospital (Poliomyelitis Pavilion), ver. Vancouver. Veterans' Hospital, Victoria. (A number of the larger public hospitals also have rehabilitation units.) Extended Care Hospitals Mount St. Mary Hospital, Victoria (exclud- Pearson Hospital, Vancouver (excluding fa- ing top floor). cilities for tuberculosis patients). Mount St. Francis Hospital, Nelson. Valleyhaven Hospital, Chilliwack. Mount St. Joseph's Hospital, Vancouver (top Veterans' Hospital, Victoria (extended-care floor). unit). Menno Hospital, Abbotsford. Shaughnessy Hospital, Vancouver (extended- Priory Hospital, Colwood (24-bed unit and care unit). 71-bed unit). 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 1967 there were 90 public general hospitals approved to accept B.C.H.I.S. patients. Care was also provided in eight outpost hospitals, five Federal hospitals, seven contract hospitals, five public rehabilitation hospitals, HOSPITAL INSURANCE SERVICE, 1967 O 39 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 1967 there were 15 hospitals providing extended care. Data for the year 1967 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 310,500 B.C.H.I.S. adult and children patients were separated (discharged) from British Columbia hospitals in 1967, an increase of 10,982 or 3.7 per cent over 1966. This table also shows that 95.3 per cent of the total patients separated (discharged) from British Columbia public hospitals were covered by hospital insurance, compared to 95.0 in 1965 and 95.2 in 1966. Table 1b indicates in 1967 that the British Columbia Hospital Insurance Service paid public hospitals in British Columbia for 2,943,700 days of care for adults and children, an increase of 82,440 days or 2.9 per cent over 1966. As shown in Table 2a, the average length of stay of British Columbia adult and children patients in public hospitals during 1967 was 9.48 days, and the days of care per thousand population were 1,752. For comparison purposes, the data for extended care hospitals is not included in the above observations, but it should be noted that an additional 183 days of care per thousand population were provided for these patients. O 40 BRITISH COLUMBIA Table 1a. — Patients Separated (Discharged or Died) and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public Hospitals Only, 1949-67 (Excluding Federal, Private, and Out-of-Province Hospitalization) (Including Rehabilitation Hospitals). Total Hospitalized in Public Hospitals Adults and Children Newborn 164,964 26,272 172,645 26,205 181,160 27,096 188,355 28,675 200,893 30,712 206,992 31,984 216,743 33,190 227,359 35,118 228,917 37,376 236,859 38,374 245,766 39,039 261,128 39,599 271,609 38,226 277,073 37,697 285,998 37,231 292,119 35,688 301,510 33,555 314,585 32,488 325,800 32,600 Total Covered by B.C.H.I.S. Adults and Children Newborn Total Patients separated— 1949 1950 1951 1952 - 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 - 1965 --. 1966i__ 19672.. Percentage of total, patients separated- 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 19661.. 19672- 191,236 198,850 208,256 217,030 231,605 238,976 249,933 262,477 266,293 275,233 284,805 300,727 309,835 314,770 323,229 327,807 335,065 347,073 358,400 140,168 144,959 150,116 154,336 169,167 189,713 199,774 208,293 209,485 222,046 234,783 249,654 259,953 264,655 272,597 278,023 286,799 299,518 310,500 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 95.3 I 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 31,100 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 95.4 164,808 168,902 174,288 179,359 196,997 219,196 231,289 241,467 244,448 259,091 273,263 288,634 297,511 301,160 308,475 312,219 318,662 330,332 341,600 86.2 84.9 83.7 82.6 85.1 91.7 92.5 92.0 91.8 94.1 95.9 96.0 96.0 95.7 95.4 95.2 95.0 95.2 95.3 1 Amended as per final reports received from hospitals. 2 Estimated, based on hospital reports to October 31,1967. HOSPITAL INSURANCE SERVICE, 1967 O 41 Table 1b.—Total Patient-days and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public Hospitals Only, 1949-67 (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— 1»40 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 3,095,700 213,874 212,979 214,285 214,701 220,208 226,031 227,674 233,402 240,872 244,429 248,074 249,273 240,207 274,032 270,298 260,979 245,756 235,796 237,700 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 3,333,400 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 2,943,700 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 95.1 200,585 193,307 187,891 184,160 197,100 213,587 212,514 217,252 223,079 232,390 239,871 241,157 231,043 263,475 257,736 246,813 230,096 220,270 221,700 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 93.3 1,631,231 1010 1,669,922 1951 1,654,993 1<«7 1,754,134 1Q<;-. 1,909,978 j 954 2,168,410 1Q« 2,217,679 1956 ... 2,259,106 1957 2,299,415 1<"8 2,402,287 1959 I960 2,514,998 2,692,996 1Qfi1 2,777,387 1962 2,837,109 1963 2,889,407 1964 2,916,989 1965 2,977,328 19661. 19672 3,081,530 3,165,400 86.0 Percentage of total, patient-days— IQ40 1950 84.4 1951 82.3 1957, 82.3 1953 84.4 1954 90.8 1955 .. . . .. 91.4 1956 91.3 1957 91.3 1958 93.6 1959 __:= 94.7 1960 95.1 1961 95 3 1967, 95.1 1963 94.8 lOfi-L 94.7 1965 94 0 19661 95 0 19672 1 Amended as per final reports received from hospitals. 2 Estimated, based on hospital reports to October 31,1967. O 42 BRITISH COLUMBIA 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, 1949-67. Total (Excluding Extended Care) B.C. Public Hospitals Other B.C. Hospitals, Including Federal and Private Institutions Outside B.C. Extended Care Hospitals (Including Federal) Adults and Children Newborn Adults and Children Newborn Adults and Children Newborn Adults and Children Newborn Patients separated— 1949 149,280 154,643 159,739 164,379 180,149 199,974 209,999 219,218 221,585 236,770 251,393 264,120 273,293 278,021 286,753 293,144 301,522 314,391 324,321 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 3,186,415 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 9.82 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 31,500 203,197 196,333 190,948 187,923 200,738 215,507 215,980 221,022 228,875 238,112 244,615 244,480 233,794 266,351 260,771 249,827 232,438 222,475 224,210 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 7.12 140,168 144,959 150,116 154,336 169,167 189,713 199,774 208,293 209,485 222,046 234,783 249,654 259,953 264,655 272,597 278,023 286,799 299,518 310,500 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 2,943,700 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 9.48 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 31,100 200,585 193,307 187,891 184,160 197,100 213,587 212,514 217,252 223,079 232,390 239,871 241,157 231,043 263,475 257,736 246,813 230,096 220,270 221,700 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 7.13 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 9,221 45,960 65,326 62,771 68,892 75,518 66,960 75,599 79,428 93,980 141,925 173,343 169,401 182,690 183,042 187,714 199,164 205,488 212,413 196,215 6.48 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 21.27 151 173 171 161 229 199 361 457 668 665 514 241 151 157 169 149 114 101 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 1,018 878 619 541 360 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 4.80 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 4,600 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 46,500 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 10.11 198 220 244 308 322 79 159 159 182 214 263 267 259 280 279 307 263 237 325 1,466 1,738 1,902 2,789 2,285 669 1,195 1.030 1950 1951 1952 1953 1954 1955 1956 1957 1958 _ 1959 1960 1961 1962 1963 1964 1965._ 19661 19672 699 Patient-days— 1949 1950 1951- 1952 1953 _ 1954 1955 1956 1957 1,497 | 1958 1.609 I 1959 1960 1,926 1,906 1,873 2,026 2,017 2,136 1,723 1961 1962 1963 1964 1965 19661 19672 1,664 2,150 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 6.62 305,940 357,200 Average days of stay— 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 = 1959 1960 1961 1962 1963 1964 1965 19661-- 19672... 437.68 435.08 1 Amended as per final reports from hospitals. 2 Estimated, based on hospital reports to October 31, 1967. 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, 1,752. (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 163 in 1966 and 183 in 1967. Population figures are revised according to latest census figures. HOSPITAL INSURANCE SERVICE, 1967 O 43 Table 2b.—Summary of the Number of B.C.H.I.S. In-patients (Including Extended Hospital Care Patients) and Short-stay Patients, 1949-67 Total Adults, Children, and Newborn In-patients Estimated Number of Emergency and Minor-surgery Patientsi Total Receiving Benefits 1949 1950 1951 1957 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 29,000 44,502 47,656 46,767 52,582 63,621 70,553 76,375 83,530 91,883 100,292 107,312 121,000 128.000 203,269 223,481 231,982 236,63® 1953 ... 1954 1955 261,112 293,356 312,5®7 1956 1957- 329,376 340,92® 1958 366,577 1959 1960 390,942 410,920 1961 1962 432,261 442,963 1963 1964 323,079 135,000 327,796 Ml.OOO 333,762 160,000 346,083 175,000 355,821 195,000 455,079 468,796 1965 493,762 19662 _ 521,083 19673 _ 550,821 Totals — 5.099.860 1.869.073 1 6.968.933 1 Years 1962 to 1967 estimated. 2 Amended as per final reports received from hospitals. s Estimated, based on hospital reports to October 31,1967. 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 19671 (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— 310,500 31,100 2,943,700 221,700 9.48 7.13 110,500 9,100 1,244,200 71,200 11.26 7.82 100,500 11,650 854,000 80,200 8.50 6.88 53,250 6,700 492,300 47,200 9.25 7.04 36,400 2,900 279,400 18,300 7.68 6.31 9,850 750 73,800 4,800 7.49 6.40 i Estimated, based on hospital reports to October 31,1967. O 44 BRITISH COLUMBIA 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 19671 (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. Per Cent 100.00 100.00 100.00 100.00 Per Cent 35.59 29.26 42.27 32.12 Per Cent 32.37 37.46 29.01 36.18 Per Cent 17.15 21.54 16.72 21.29 Per Cent 11.72 9.33 9.49 8.25 Per Cent 3.17 2.41 Patient-days—• Adults and children 2.51 2.16 i Estimated, based on hospital reports to October 31,1967. 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 50 to 53 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 1966 " and " Statistics of Hospitalized Accident Cases, 1966," available from the Research Division. HOSPITAL INSURANCE SERVICE, 1967 O 45 v© vo O. r—1 „ CO - D -_ O w P. J O o « P. H r/l O z o < )—t Q p. o ^ < s >< co . . fi * w HJ q P. p_ < o u a Ph z o 5 cn z K* w < o Q to w Ph O Q z z o v ' H D M 2 H cn Q w H o < < S H P. 1 u * SR g< 0^ p. ^ " £5. o U prf ' O 46 BRITISH COLUMBIA vo VO w P. < u Ph o < Q Q Z < co a CO Ph CO O K * < p-i rM O z < 3 Ph O H P pa 5 E-i co q w H Z P. o p. P4 H Ph o £ IX, ?. « I" (T, ^ ON t 3\ 0 £< ^ 00 K K ^ ^0 "^ $S # O i^0^vO«^0«^0"^Of ooOOlXKVO vo^v^-v^-t|-i^ o ^ o s^ SI o ss u __, O 5 " o § c II Oh n .<y o . > p — 11 u ■fl VW c X M d B C3 6 TJ 3 o iH o F3 c c H * OJ S +- HOSPITAL INSURANCE SERVICE, 1967 O 47 VO OV w O P3 on ►J u z I—I >H O Ph O w Ph Ph * CO W CO < u ►J H Ph CO @ Ph O z 2 H s s H CO Ph < H Z P. u p. Ph Oh H P. W E O 48 BRITISH COLUMBIA VO VO Ov w u p. W5 ►J < u z u Ph o a Ph H Ph * CO < Q 1-1 < w ►J < w Ph o X Ph O z o H 2 2 PS O <: H z p. u p< pa Ph > I—I H fi < 5 HOSPITAL INSURANCE SERVICE, 1967 O 49 Chart V.—Average Length of Stay of Cases* in Hospitals in British Columbia, by Major Diagnostic Groups in Descending Order, 1966 (Excluding Newborns). Diseases of the circulatory system Diseases of the bones and organs of movement Diseases of the blood and blood-forming organs Neoplasms Diseases of the nervous system and sense organs Congenital malformations Allergic, endocrine system, metabolic, and nutritional diseases Certain diseases of early infancy Mental, psychoneurotic, and personality disorders Infective and parasitic diseases Injuries and adverse effects Diseases of the digestive system PROVINCIAL AVERAGE LENGTH OF STAY 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 llllllllllllllllllllllllllllllllllll ■>■> /III/II/IIII/I////I///I/IIIIIIII, Wllllllllllllllllllllllllllllll - lllllllllllllllllllllllllllllllllli. 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Ilia 3 »°1 « •m .M _. _a u 3 & ° a .5 8 £ SB* '_: '__ 3 2 0 8 5- _. ■- ■— <— o A .£ 3 oi " — .— G 4> OJ UOO.^H.H-iu 3 3 3 *o __: d ™ w a u W g rH rt « a 2- h «J .fi ca 3 « .b3 ^ ij .to 3 '-3 «h s y "3 b ° X J9 fa § m 2 ft g « 121 s a a w S3 cfl Sfll *j ao"0 j- 3 8 3 S 5 O .3 -3 Ocn Tt m vo r*- r- r- r- c^ t- ■v CO I co co oo U co U oo „ o >> 3 E, i 3 S u aj j Ea a « >, 1 -9 % E rt f >? * § ■'3 •C to *3 3 I e &«■ »o_5 S Kai'Sl a ..a V. oo i3 c (rt fa ll " u w g .S & a CO 3 <4H OOO 4> 4> 4) . '■— '—< l- <^ I o a ob » g i£££53 a 2 * 3 13 cd r. 3 C a i a 0 a 5 6 a s_ H to „ > > 5 s HOSPITAL INSURANCE SERVICE, 1967 O 53 NOOON o oooo©o © Tt © O O Tt o © © © © O © j© 1 ra q © oo *-4 oo in th oo Tt in ov rH CN rH rt VO Oi Ifl IH; t- co Tt oo o Tt rH Cv) OV vo vo to OV co" 00 rH rl vo OV cn Tt CO (O CN CN cn vo CN cn f*Ov CN CJ vo 00 Ov CNCNqo YOO-2 YOO 22, 23, 24,25, YOl-l O rH CN CN r»r» i co ,3 1 £ O .5 00 .a •o 3 o s\ V CO 4 11 i o 6 C o co" i CJ 3 a J 3 O M 3'I a o *- a T3 8. __ •| 3 t3 ™ c « a| tu w cn c ,. M Is •2 a 3 rr 2 r 9" £ ■a o IS E o £ C •O HH CO 73 73 a « el B'S a a « a a in H flll SS5 5 . .21" vd t^ oo &0 o\ Ov Ov Ov ,_; B O 54 BRITISH COLUMBIA STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR THE FISCAL YEAR ENDED MARCH 31, 1967 Administration— Salaries $641,759 Temporary assistance 14,895 $656,654 Office expense 39,967 Travelling expense 40,306 Office furniture and equipment 12,827 Printing and publications 2,370 Tabulating and rentals 2,584 Motor-vehicles and accessories 1,902 Incidentals and contingencies 1,514 Construction and consulting fees 622 Technical surveys 17,592 $776,338 Less transfer, Vote 129 (b)—Salary Adjustments 28,656 $747,682 Payments to hospitals— Claims $90,949,925 Vancouver General Hospital re out-patients (Hospital Insurance Act, sec. 17 (3) (c)) 284,689 91,234,614 Grants in aid of construction of hospitals 5,738,713 Total $97,721,009 Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1968 700-867-7425
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Nineteenth Annual Report British Columbia Hospital Insurance Service JANUARY 1 TO DECEMBER 31 1967 British Columbia. Legislative Assembly [1968]
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Title | Nineteenth Annual Report British Columbia Hospital Insurance Service JANUARY 1 TO DECEMBER 31 1967 |
Alternate Title | HOSPITAL INSURANCE SERVICE, 1967 |
Creator |
British Columbia. Legislative Assembly |
Publisher | Victoria, BC : Government Printer |
Date Issued | [1968] |
Genre |
Legislative proceedings |
Type |
Text |
FileFormat | application/pdf |
Language | English |
Identifier | J110.L5 S7 1968_V02_08_O1_O54 |
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 | 2018-04-11 |
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 | 10.14288/1.0365679 |
AggregatedSourceRepository | CONTENTdm |
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