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PROVINCE OF BRITISH COLUMBIA "HOSPITAL INSURANCE ACT" Sixth Annual Report B.C. Hospital Insurance Service… British Columbia. Legislative Assembly 1955

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 PROVINCE OF BRITISH COLUMBIA
"HOSPITAL INSURANCE ACT"
Sixth Annual Report
B.C Hospital Insurance
Service
JANUARY 1st TO DECEMBER 31st
1954
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1955
  Victoria, B.C., January 25th, 1955.
To His Honour Clarence Wallace, C.B.E.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
II    The undersigned has the honour to present the Sixth Annual Report of the B.C,
Hospital Insurance Service covering the calendar year 1954.
E. C. MARTIN,
Minister of Health and Welfare.
 11|L    .-Mr B-C Hospital Insurance Service,
jl Victoria, B.C., January 25th, 1955.
The Honourable E. C. Martin,
Minister of Health and Welfare,
Parliament Buildings, Victoria, B.C.
Sir,—I have the honour to present herewith the Report of the B.C. Hospital Insurance Service covering the calendar year 1954.
j    | I   ■■  If | '     D. M. COX,
Commissioner, B.C. Hospital Insurance Service.
 f: CONTENTS.:;:*! %   M
Page
General Introduction _     7
s"^ Financial (a)^- j 4-/.^^BIi •■:# ':.%'-"         •^^^ft" ;        ■-■■■''     ■ • • JU ~
1    J| Revenue. — _ ||  __________    7
Financial (b)—Si^^   ^^^^M   :fv' ^^^^^S "W;'#   -   •
HI'--       Claims and Accounting ______ ____________ j  g
Zt   ft   Methods of Payment to Hospitals j  8
M   Hospital Services —— ____—___________________ _ __  8
H   Summary .   9
Organization and Administration-—-.^SlN||f.-    1M&-■■?§■ jfe
Terminating Premium Payment Plan 1  9
Eligibility Division and Field Staff  9
Administrative Assistant  9
General Office j   10
Research Division  10
Hospital Services Group !  10
Hospital Finance Division—
Hospital Claims Section  10
Hospital Accounting Section  11
Hospital Consultation and Inspection Division, Victoria-  11
Hospital Consultation and Inspection Division, Vancouver  11
Medical Consultation Division .  12
Hospital Construction Division  12
General Hospital Care 1  13
Table I.—Patients Discharged and Days of Care in B.C. Public Hospitals,
1949-54, and Proportion Covered by B.C. Hospital Insurance Service  14
Table IIa.—Patients Discharged, Total Days' Stay, and Average Length of Stay
According to Type and Location of Hospital, and Days of Care per Thousand of Covered Population for B.C.H.I.S. Patients Only, 1949-54  15
Table IIb.—Summary of the Number of B.C.H.I.S. In-patients and Short-stay
Patients, 1949-54  15
Table III.—Patients Discharged, Total Days' Stay, and Average Length of Stay
in B.C. Public Hospitals for B.C.H.I.S. Patients Only, Grouped According
to Bed Capacity, Year 1954  16
Table IV.—Percentage Distribution of Patients Discharged and Patient-days for
B.C.H.I.S. Patients Only, in B.C. Public Hospitals, Grouped According to
Bed Capacity, Year 1954  16
Graphs—
Six of the Leading Causes of Hospitalization, February 1st to October 31st, 1953 17
Average Lengths of Stay for Nineteen Major Diagnostic Categories of Illness,
February 1st to October 31st, 1953   18
Case Fatality Rates for Nineteen Major Diagnostic Categories of Illness, February 1st to October 31st, 1953   19
5
 cc 6 BRITISH COLUMBIA
Statements—  • 'Wm ;||||
Statement of Receipts and Disbursements for the Fiscal Year Ended March 31st *m
I 1954 _ '2o
Statement Showing Cash Reconciliation with the Public Accounts of the Province
? of British Columbia as at March 31st, 1954 ____„„.    2i
Benefits in B.C. Hospitals, 1954 1 1|—_ 22
Benefits in Hospitals outside British Columbia  22
Approved Hospitals in British Columbia— —__- jj       23
Classes of Persons Covered by or Excluded from the Benefits of the Hospital Insur-It
jjt , ance Service  —.— §p 24
 Sixth Annual Report of the B.C. Hospital
Insurance Service       '&'
J      I GENERAL INTRODUCTION *       § #
The B.C. Hospital Insurance Service was established to provide the people of British
Columbia with universal and comprehensive protection against the expense of acute inpatient hospital accommodation. It serves a twofold purpose by protecting the people
of British Columbia from costly hospital bills and by protecting the hospitals of British
Columbia from a large proportion of non-collectable accounts. Prior to the inception
of the B.C. Hospital Insurance Service, unpaid hospital bills ranged from 35 tp 55 per
cent in some hospitals.
During the first three months of this year the policies governing universal coverage
provided for the payment of a hospital insurance premium by, or on behalf of, every
citizen, with the exception of certain minority groups. Regulations permitted the inclusion of a wide range of family dependents, and persons receiving social assistance from
the Provincial Welfare Branch received hospital insurance coverage. However, on April
1st the "Hospital Insurance Act" was amended, and the original concept, which provided that eligibility for benefits was dependent upon premium payment under certain
specified conditions, was replaced by the policy of making benefits available to bona fide
residents. Individual premiums were abolished, and | residency " became the determining factor in establishing eligibility. '^ffff'-  llll
Comprehensive coverage is attained by providing the qualified patient with substantially all of the hospital's services. I§ M
II    Benefits consist of:— "-:-']:%-
ijl          (1) Payments at the public-ward level for treatment that can be obtained
only in an acute general hospital:
(2) Payments for emergency treatment (short-stay benefits);  and
pfe, (3) Payments for treatment in hospitals outside British Columbia (out-of-
ijiljr Province benefits).
|§.   For details regarding benefits, refer to page 22.
H   The B.C. Hospital Insurance Service has two mirin functions—financial and hospital services.   The financial aspect comprises two main parts, as follows:—j
iB^'^--- ■■■■:M Financial (a)
Revenue
On April 1st, 1954, individual premium payments were abolished. |The majority
of funds necessary for the operation of the Service is now obtained from consolidated
revenue, which has been augmented by an increase in the social services tax from 3 to
5 per cent. Another source of revenue is the Provincial and municipal per diem grants.
In accordance with the | Hospital Act," the Provincial Government pays to the Hospital
Insurance Service 70 cents for each day's treatment rendered by acute general hospitals
in British Columbia. City and district municipalities pay 70 cents for each day's treatment rendered to persons defined &s municipal residents under section 32 of the " Hospital Act." Ill
The new concept made "residency " the determining factor for eligibility and new
regulations specified certain conditions required by the applicant for benefits. (See
Classes of Persons Covered by or Excluded from the Benefits of the Hospital Insurance
Service, page 24.)
7
 CC 8
BRITISH COLUMBIA
A patient requesting benefits under the g Hospital Insurance Act" is required to
complete an Application for Benefits form when hospitalized. The hospital then verifies
the statements regarding residency and, if the patient is a resident as approved under
the 1 Hospital Insurance Act" and regulations, it then requests payment of the account
by the Hospital Insurance Service. The Government will pay a hospital account on the
certification of the hospital that the individual is a qualified resident, provided the hospital takes adequate steps to verify the statements concerning residency made by the
patient or on his behalf. However, it reserves the right to reject any account where the
statements regarding residence do not meet the requirements of the | Hospital Insurance
Act."   (See Eligibility Division and Field Staff, page 9.) ||r      ||    |jl  ffjj
s^^^fc' -^^^^^^^^m. iili financial (ft)|_^pi^w^^*"!/^
Claims and Accounting
IlllSPayments to hospitals form the second part of the financial aspect of the Service,
organized under the Hospital Services Group (see page 10). This is accomplished by
the payment of qualified patients' hospital expenses at daily rates established under the
budget system (below).
Methods of Payment to Hospitals
Hfb A system of firm budgets was instituted for hospitals, effective January 1st, 1951,
whereby hospitals' estimates were reviewed by the Rate Board of the Hospital Insurance
Service. After adjusting where necessary, budgets were established. Hospitals were
advised they would be required to operate within their approved budgets, with the
exception of certain items (particularly fluctuation in days' treatment). Deficits incurred
through expenditures in excess of the approved budget would not be met by the Provincial Government. The value of variable supplies used in patient care was calculated.
When the numbers of days' treatment provided by the hospital differed from the estimate,
the budgets were subject to adjustment by the number of days' difference, multiplied by
the patient-day value of the variable supplies. Individual studies were made in those
instances where large fluctuations in occupancy involved additions or reductions in standby costs, and budget adjustments were made.
This procedure was modified during 1953. Per diem rates were not increased and
the 1952 budget was continued. However, authority was given the Service to increase
a hospital's budget up to the amount of the 1953 salary increases for employees included
in the 1952 approved budget, where the wage increases caused the hospital to incur a
deficit.
Hospitals treat a certain number of non-B.C.H.I.S. patients (Workmen's Compensation Board, non-qualified persons, etc.), and every month the Service pays each hospital one-twelfth of the yearly budget represented by the B.C.H.I.S. insured days, as
compared to the total days' treatment. By the end of the month each hospital is advanced
the approximate amount required to cover B.C.H.I.S. patients, including those remaining in hospital at the end of the month. (It is interesting to note that since the introduction of the new policies on April 1st, 1954, approximately 93 per cent of all patients
have been covered by the Service, as compared with 85 per cent during 1953.) One
dollar a day is charged qualified patients, and the sum is deductible in calculating payments due hospitals from the Service. Hospitals charge non-qualified patients the established per diem rates.
f Hospital Services   If    ' If :,%' ''*?&. jj      • JL
Maintaining high standards of patient care is the other main function of the Hospital Insurance Service (see Hospital Services Group, page 10). The group of staff
consultants who share this responsibility are organized into the following divisions:-
 HOSPITAL INSURANCE SERVICE REPORT, 1954 Cc 9
^^tf^l - Hospital Finance:   To advise hospitals on problems of accounting, finance,
;f|; "3^*'     ♦ purchase of equipment, and review hospital accounting records and finan^
. cial reports.-^^^   #-  " %   '        --#'11
Hospital Consultation and Inspection:   To assist hospitals with administrative
and operational problems, and ensure that proper standards of patient
J|    j|. care are maintained.
Medical Consultation:   To review all medical matters related to the Service
ff '    , under the advice and guidance of the Medical Review Board.
^p.       Hospital Construction:   To advise hospitals planning new construction and
&jj£$%$^ renovation, and process applications for grants for construction.
fjfr;      if Research:   To conduct studies relating to hospital occupancy, and prepare
l§       :J|;    medical and financial information pertaining to the hospital requirements
of the Province.
ft II Administrative Assistant: To assist in the formation of hospital districts in
^^p ft areas where no municipal organization exists, and give guidance in the
§| review of hospital by-laws and related problems. Jt
f   " Summary
■ijfjln summary, the B.C. Hospital Insurance Service protects B.C. residents from costly
hospital bills and B.C. hospitals from a large percentage of non-collectable debts. Maintenance of high standards of care is assured patients, and the hospitals' autonomy as a
community function is maintained, although the Hospital Insurance Service exercises a
certain degree of over-all financial control. ^^^^^iP^ #
% #  > ;      I ORGANIZATION AND ADMINISTRATION   '      - :. ;^;:J^P
3|Bf lt^>il jk Terminating Premium Payment Plan      |^.-^alL  ..'
Premium payments were abolished, effective April 1st, and the change in concept
necessitated the entire reorganization of the Service. A new plan of organization was
drawn up. With the abolition of direct individual premium payment it became necessary
to refund all premiums paid beyond March 31st, 1954. This operation entailed the
preparation and mailing of 377,303 cheques, totalling a net refund of $3,887,136.23_
A custodial staff was maintained to answer inquiries from the general public regarding
premium refunds. ^ IP
*Pk   iljf Eligibility Division and Field Staff ^
To assist in the application of the new policy, field representatives were located in
Victoria, Vancouver, Nelson, Kamloops, Kelowna, and Prince George. Their work
involves a review and audit of application forms received by the hospitals. . In a 2V_t-
morith period, 32,220 applications were received for review.  |T':|;" g £
Administrative Assistant   ^^     -^r '^^'    :'lIB8
This office assumed the responsibility of the former Liability and Adjustment Division. It is responsible for liaison between the B.C. Hospital Insurance Service and the
Attorney-General's Department, and prepares legislation, regulations, and Orders in
Council. It ensures a uniform interpretation of the various Acts and regulations by
providing a consulting service for the offices in the Service.  J|      ||: |        ^fc
# In conjunction with the Hospital Consultation and Inspection Division, hospitals are
assisted in the review and revision of by-laws. This office also assists communities in
unorganized territory to establish hospital improvement districts for the purpose of raising
funds for hospitals, : .       - \ ^^^     ■i^W!  ^ ^   ^W^-
 CC 10
BRITISH COLUMBIA
Reports are compiled on all persons receiving hospital treatment as a result of an
accident, and reimbursement of hospital bills paid by the Hospital Insurance Service is
secured from public liability insurance companies and self-insured corporations.
General Office
A General Office was organized, which assumed responsibility for the functions of
the Departmental Comptroller's office. This office also has custody and control of all
records left by the former Payroll and Central Accounts Divisions, and Revenue Control,
and it assumed personnel and staff payroll duties. It administers the requisitioning and
inventory of supplies, furniture, and equipment, and is responsible for mail distribution
and the shipping of all supplies. A duplicating service is operated for internal use, and
a teletype service maintained between Victoria and Vancouver for use by all Civil Service
offices in Victoria and the Greater Vancouver area.
Public relations duties included publishing general information about the new policy
and the editing of instructional circulars distributed to all hospitals. A library of 16-mm.
sound film is also maintained for use by hospitals and other interested groups.  §
Research Division
.yj| The primary functions of this Division are to analyse and prepare studies in Provincial hospitalization experience, bed requirements for acute care, incidence of sickness,
population trends, and generally any analogous matters relating to the administration of
the Insurance Service which require detailed investigation.
Hospital Bed Facilities.—A survey was completed on the bed requirements for acute
care in the Lower Fraser Valley Hospital Region, consisting of the eighteen school
districts and the Fraser Canyon, to determine the number of hospital beds which would
be required to meet the needs of this region, and to suggest the areas to which these beds
should be allocated.   Similar smaller studies were made of four other areas.
Causes and Duration of Hospitalization.—Studies were commenced on the causes
of hospitalization among B.C. residents and the causes of variation among areas in the
average period of hospitalization.
|gg} Other Activities.—Methods of coding and recording the medical data on the I.B.M.
punch-cards were studied and, in some instances, expanded. A geographical code was
prepared to determine more precisely the incidence of hospitalization in terms of the
residence of the patient. Statistical information pertaining to hospitalization and disease
incidence was supplied to the Provincial Government and Federal Government agencies
throughout Canada and the United States.
|§t Hospital Services Group
The Hospital Services Group deals with hospitals and hospitals' affairs and comprises
the Hospital Finance, Hospital Consultation and Inspection, Medical Consultation, and
Hospital Construction Divisions.
Hospital Finance Division
Hjf Hospital Claims Section.—The main responsibilities of this Section are to process
hospital accounts for payment and to screen applications for benefits. The new hospital
insurance plan resulted in more claims being received by the Service. Claims for qualified
employees of previously exempted groups, such as the Canadian Pacific Employees
Medical Association of British Columbia, the Telephone Employees' Medical Services
Association of British Columbia, and Social Welfare recipients, are now paid by this
Service. During the year 235,510 hospital accounts were paid, as compared to 208,111
in 1953.   Included in this total were 2,738 out-of-Province accounts, paid on behalf or
 HOSPITAL INSURANCE SERVICE REPORT, 1954 CC 11
qualified persons admitted to hospitals in other Provinces of Canada, the United States
Central and South America, Europe, and other areas of the world. !
Approximately 950 admission notices received daily were screened for diagnoses in
conjunction with the Medical Consultation Division. An equivalent number of hospital
accounts were processed for payment. |     I
Applications for benefits are checked for accuracy and referred to the field representatives for investigation, where necessary. This Section also administers the billing and
collection of municipal per diem grants, and individual hospital accounts are checked to
determine the municipality responsible. j|
Patients' records for the previous year, approximating 600,000 documents, were
microfilmed. it       if #
Hospital Accounting Section.—Primarily concerned with hospital budgets, this Section maintains close working relationships with hospitals. Frequent inspections'are made
of hospital financial, statistical, and accounting records. When the accounting staff of
smaller hospitals require assistance, and local help is not available, this Section will send
an accountant to write up the books and, where necessary, help train new staff.
This Section also checks and amends financial and statistical reports, prepared by
hospitals for the Dominion Bureau of Statistics; studies and recommends for approval
requests made by hospitals for payment of grants in connection with capital expenditures
for equipment; audits accounts relating to hospital-construction projects, in collaboration
with Federal Treasury officials; carries out accounting studies in nursing homes and
chronic hospitals, at the request of the Provincial Welfare Branch, to assist in establishing
rates to be paid for the care of welfare patients; collates with the approved budget
statistical reports and revenue and expenditure statements received from hospitals on
a monthly basis; calculates cash advances forwarded to hospitals semi-monthly.
This section prepared the Annual Report on Hospital Statistics for 1953. ^fl
Hospital Consultation and Inspection Division, Victoria
ff Hospital inspection and administrative assistance comprise the main functions of
this Division.
During the year, hospitals were inspected, requiring visits ranging from one day to
one week's duration. |§
Revision of By-laws.—In conjunction with the office of the Administrative Assistant, draft by-laws of twenty-two hospital societies were processed. Reference material
was also provided to the medical staffs of those hospitals active in developing new medical-staff by-laws/ff Eight sets of newly developed by-laws were reviewed.
Information on personnel matters was distributed to hospitals. If
This Division continued to assist in reviewing hospital estimates, plans, and proposed sites, and to study requests for equipment grants. The Division was represented
on the Hospital Rate Board.
In accordance with the co-operative arrangement started by this Service in 1952,
nutrition consultants of the Provincial Health Branch visited nine hospitals to study
dietary problems. j| jg     |
During the year, information was assembled relative to the day-to-day utilization
of beds in the Greater Vancouver and New Westminster areas. :^ iil§
Hospital Consultation and Inspection Division, Vancouver
During 1954 the Vancouver office carried on a hospital consultation and inspection service. It also recommended for licence and inspected private hospitals, screened
applications for admission to the Provincial Infirmary, and maintained a hospital-
clearance programme. I I
There were fifty-three licensed private hospitals in the Province as at December
31st, 1954.
 CC 12
BRITISH COLUMBIA
H* Cases Referred.—Two hundred and seventy-nine cases, with which hospitals experienced placement difficulties, were referred by general hospitals. There were also eighteen
inquiry cases where interpretation regarding hospital-clearance  cases was given to
hospitals.
This office received twenty-nine inquiries which did not pertain to either hospital
clearance or private hospitals, but concerned situations where hospitals, or persons, were
requesting information as to procedures involving other departments of the Government.
There were seventy-five inquiries regarding the establishment of private hospitals. Two
new private-hospital licences were issued, and three private-hospital licences lapsed.
!§f Inspectorial Visits.—An annual inspectional visit was made to all licensed private
hospitals. A thorough investigation was made of any complaints received with respect
to the operations of any private hospital. ff    ^^^p       "f|Si;  ijpf
Many private hospitals made inquiries with respect to improving conditions and
service facilities, and a large number established diversional and recreational programmes
for patients.
Sti Of the ninety-eight applications received for admission to the Provincial Infirmary,
ninety-six were recommended.
f This Division continued to administer the | Mental Hospitals Act," sections 6 and 7.
There is one licensed private mental hospital in the Province, and two homes under
observation and inspection by the Inspector of Hospitals for the Medical Superintendent
of the Provincial Mental Hospital, under section 6 of the 1 Mental Hospitals Act."   11
Medical Consultation Division
The main function of this Division is to provide a source of technical knowledge for
use by all branches of the Service.
The Medical Consultant and the Commissioner represent the Hospital Insurance
Service on the Medical Review Board, which, by its advice and guidance, helps maintain
good public relations among the Service, the medical profession, and the hospitals. The
remaining three members of the Board are physicians, designated by the College of
Physicians and Surgeons of British Columbia.
The Medical Consultant and his staff review all admission and discharge records
before being passed for payment. Discharge diagnoses are carefully scrutinized and
coded in accordance with the Manual of International Statistical Classification of Diseases,
Injuries, and Causes of Death. Correct diagnostic classification is essential in the
compilation of accurate medical statistics.
Hospital claims are checked for length of stay, and particular attention is given the
claims of chronic and short-stay patients. Out-of-Province claims are reviewed and the
hospitals concerned checked to ensure they meet the required standards. ^;
Hospital Construction Division
This Division renders an advisory service to hospitals, hospital societies, or hospital
groups contemplating new construction, improvements to existing buildings, reconstruction, or major additions to existing facilities. Very close liaison is maintained with
Federal authorities to ensure that Federal standards of construction are maintained,    m
Reference material on planning and designing hospitals, and information on the
cost of hospitals built since the inception of the Service, is available upon request. Advice
on site selection is given, and special forms are provided to assist in appraising proposed
sites. Matters pertaining to sanitation and nutrition are referred to the Provincial Health
Branch. The Inspector of Electrical Energy, the Provincial Fire Marshal, and the Steam-
boiler Inspection Branch of the Public Works Department also co-operate in the. approving of proposed plans.
 HOSPITAL INSURANCE SERVICE REPORT, 1954 CC 13
The following is a list of projects that were completed during the year 1954:—..T
:      (1) Trail-Tadanac Hospital, Trail—replacement of addition to M
:r-r'^f hospital plus additional beds; total beds_:___ ___________________:__■ 154 ^5^|S
:Jr (2) White Rock Hospital, White Rock—new hospital facility;
^K^"   ^ new beds _ _"_     42
|f|    (3) Tofino General Hospital, Tofino—replacing former hos-
__—   ^"-"pitai wttcli was burned down; new beds:z__-__:::______: __:__„-_    17 358—«_*-
tt     (4) Royal Jubilee Hospital, Victoria—construction of addition :if
\m    Jj     to psychopathic unit; new beds„__■_ 1      g
H     (5) King's Daughters' Hospital, Duncan—addition to existing Jg;-.
Iff   |f     hospital building; total beds J     12     3fefe'
It'    (6) Western Society for Rehabilitation, Vancouver—addition   £
JH'-      I to existing building plus  administration and treatment   f§
K- areas; new beds    20
K    (7) Holy Family Hospital, Vancouver—new chronic and convalescent hospital; new beds __     52
||     (8) North Vancouver General Hospital, North Vancouver—
^^_^rtS alterati°ns and renovations to provide additional beds and
ii^^^^ enlarged service areas; net bed gain       6
Pf    (9) Vancouver General Hospital, Vancouver—conversion of
111        I West Wing of the Semi-private Pavilion for paediatric beds; i||&      1
III    I       net bed gain.___ ffl     32        ,'.. :C:-,
(;10) Gorge Road Hospital, Victoria-—chronic convalescent,
replacing existing beds plus additional beds; total beds  104
- — ---^^^^ Total 'bedsr___-____________:.__________-____________  447 -^rw^
In 1954, construction was also commenced on the following projects:—
(1) A new addition to St. Paul's Hospital, Vancouver, at an estimated cost
of $1,300,000.    I 1
(2) A new 51-bed hospital and 16-bed nurses' home at Quesnel, at an estimated cost of $720,000. Ill
(3) A 36-bed addition to the Bulkley Valley District Hospital at Smithers, at
an estimated cost of $232,000.
GENERAL HOSPITAL CARE
Statistical data compiled by the Hospital Finance Division are presented in the tables
on the following pages. The data deal with the volume of hospital care provided to the
people of British Columbia through the Hospital Insurance Service. Eighty-one public
hospitals were approved to accept B.C.H.I.S. patients. In addition, a proportion of care
was given in Red Cross outpost units, veterans' hospitals in Victoria and Vancouver,
private hospitals, and in company-operated hospitals in remote areas.
Data for the year 1954 have been prepared from preliminary unrevised reports
submitted by the hospitals, and consequently are subject to minor revision.
The average length of stay of B.C.H.I.S. adult and children patients in B.C. public
hospitals increased from 10.13 days in 1953 to 10.31 in 1954. Total adult and children
days covered by the Service in B.C. public hospitals during 1954 were 1,955,721, an
increase of 242,843 or 14.2 per cent over 1953.
During 1954 a total of 189,735 B.C.H.I.S. adult and children patients were discharged from B.C. public hospitals, an increase of 20,568 or 12.1 per cent over 1953.
The marked increase is due to the changes in policies effective April 1st, 1954, and to
additional hospital beds being made available.
 CC 14
BRITISH COLUMBIA
Table I.—Patients Discharged and Days of Care in B.C. Public Hospital*
1949-54, and Proportion Covered by B.C. Hospital Insurance Service
Total Hospitalized
Adults and
Children
Patients discharged—
1949	
1950	
1951 __
1952	
19533 M	
1954
Percentage of total, patients discharged—
1949 M ~~~ |	
1950 ____	
1951	
1952 _____ -,	
19533 j	
1954 pp .	
Patient-days—
1949 1	
1950 _____ m
1951- I .	
1952	
1953 3 j	
1954 I j	
Percentage of total, patient-days—
1949	
1950 _ I I	
1951 ___
1952 j	
19533 i	
1954 «__.___	
164,964
172,645
181,160
188,355
200,893
210,343
1,682,196
1,766,680
1,795,438
1,916,486
2,041,615
2,211,105
New-born
Total
26,272
26,205
27,096
28,675
30,712
30,793
213,874
212,979
214,285
214,701
220,208
225,099
191,236
198,850
208,256
217,030
231,605
241,136
1,896,070
1,979,659
2,009,723
2,131,187
2,261,823
2,436,206
Covered by B.CH.I.S.i
Adults and
Children
140,168
144,959
150,116
154,336
169,167
189,735
84.9
84.0
82.9
81.9
84.2
90.2
1,430,646
1,476,615
1,467,102
1,569,974
1,712,878
1,955,721
85.0
83.6
81.7
81.9
83.9
88.5
New-born
24,640
23,943
24,172
25,023
27,830
29,440
93.8
91.4
89.2
87.3
90.6
95.6
200,585
193,307
187,891
184,160
197,100
212,746
93.8
90.8
87.7
85.8
89.5
94.5
Totals
164,808
168,902
174,288
179,359
196,997
219,175
86.2
84.9
83.7
82.6
85.1
90.9
1,631,231
1,669,922
1,654,993
1,754,134
1,909,978
2,168,467
86.0
84.4
82.3
82.3
84.4
89.0
1 B.C.H.I.S. excludes Workmen's Compensation Board patients and days.
2 New-born total included.
8 Amended as per final reports received from hospitals.
 HOSPITAL INSURANCE SERVICE REPORT, 1954
For B.C.H.I.S. Patients Only, 1949-54
CC 15
Table Ha.—Patients Discharged, Total Days' Stay, and Average Length of
Stay According to Type and Location of Hospital, and Days of Care per
Thousand of Covered Population.
Patients discharged—
1949	
1950: _—-
1951 ,	
1952_._—__-__-_- -
1953s-
1954.....
Patient-days-
1949	
1950	
1951 _„
.. 1952	
195_2.
1954-
Average days of stay—
1949	
1950 __
1951	
1952	
1953s.. .	
1954 -	
Total1
Adults and
Children
Newborn
B.C. Public
Hospitals
Adults and
Children
Newborn
149,280
24,989
154,643
24,336
159,739
24,587
164,379
25,492
180,149
28,381
; 199,996!
29,718
1,498,121
203,197
1,564,222
196,333
1,551,954
190,948
1,663,149
187,923
1,814,344
200,738
2,046,985!
214,666
10.03
8.13
10.11
8.07
9.71
7.76
10.12
7.37
10.07
7.07
10.24
7.22
B.C. Private
Hospitals
Adults and
Children
Newborn
Institutions
outside B.C.
Adults and
Children
140,168
24,640
144,959
23,943
150,116
24,172
154,336
25,023
169,167
27,830
189,735
29,440
1,430,646
200,585
1,476,615
193,307
1,467,102
187,891
1,569,974
184,160
1,712,878
197,100
1,955,721
212,746
10.21
8.14
10.19
8.07
9.77
7.77
10.17
7.36
10.13
7.08
10.31
7.23
Newborn
7,093
151
7,617
173
7,308
171
7,431
161
8,173
229
7,602
199
45,960
1,146
65,326
1,288
62,771
1,155
68,892
974
75,518
1,353
66,960
1,251
6.48
7.59
8.58
7.44
8.59
6.75
9.27
6.05
9.24
5.91
8.81
6.29
2,019
2,067
2,315
2,612
2,809
2,965
21,515
22,281
22,081
24,283
25,948
24,304
10.66
10.78
9.54
9.29
9.24
9.14
198
220
244
308
322
79
1,466
1,738
1,902
2,789
2,285
669
7.40
7.90
7.79
9.06
7.10
8.47
1 New-born totalled separately.
2 Amended as per final reports received from hospitals.
Estimated days per thousand of population covered by B.C. Hospital Insurance Service:
1951, 1,496;   1952, 1,545;   1953, 1,638;   1954, 1,786.
1949, 1,528;   1950, 1,548;
Table IIb.—Summary of the Number of j_^^_^^^^^^^^^p
and Short-stay Patients, 1949-54
1949
1950
1951
1952
19531
|    1954         Total
Total adults, children, and new-born in-patients
Estimated number of short-stay patients	
174,269
29,000
178,979
44,502
184,326
47,656
189,871
46,767
208,530
52,582
229,714
63,621
1,165,689
284,128
Total receiving benefits	
203,269
223,481
231,982
236,638
261,112
293,335
1,449,817
1 Amended as per final reports received from hospitals.
 CC 13
BRITISH COLUMBIA
Table III.—Patients Discharged, Total Days' Stay and Average Length of Stay
in B.C. Public Hospitals for B.C.H.I.S. Patients Only, Grouped According
to Bed Capacity, Year 1954. |g§§
Patients discharged—
Adults and cMdren-
New-born |
Patient-days—
Adults and children.
New-born L
Average days of stay-
Adults and children.
New-born	
Total
189,735
29,440
1,955,721
212,746
10.31
7.23
Bed Capacity
250 and
Over
100 to 249
50 to 99
73,528
10,293
934,240
77,964
12.71
7.57
36,697
5,611
361,307
43,087
9.85
7.68
42,935
8,765
368,991
59,791
8.59
6.82
25 to 49
23,594
"3,284
184,663
21,961
7.83
6.69
Under 25
8,904
1,203
66,531
8,118
7.47
6.75 .
Special
284"
39,989
1,825
9.81
6.43
Table IV.-—Percentage Distribution of Patients Discharged and Patient-days
for B.C.H.I.S. Patients Only, in B.C. Public Hospitals, Grouped According
to Bed Capacity, Year 1954.
1
Bed Capacity
1                                         t
Total
250 and
Over
100 to 249
50 to 99
25 to 49
Under 25
Special
Patients discharged—
Adults and children .  .....  _:....
Per Cent
100.00
100.00
100.00
100.00
Per Cent
38.75
34.97
47.78
36.65
Per Cent
19.34
19.06 '
18.47
20.25
Per Cent
PI 22.63
29.77
18.87
28.10
Per Cent
12.44
11.15
9.44
10.32
Per Cent
4.69
4.09
3.40
3.82
PerCent
2.15
New-born.  _    „
0.96
Patient-days—
Adults and children    ....
New-born.	
2.04
0.86
 HOSPITAL INSURANCE SERVICE REPORT, 1954
CC 17
""BETOY THE LEADING CAUSES OF HOSPITALIZATION IN BRITISH COLUMBIA
FEBRUARY 1st TO OCTOBER 31st,  1953
Age GrOup .1 — 0- 9
Age Group 2 — 10-19
Age Group 3 — 20-29
Age Group 4 — 30-39
Age Group S1-:—^40-49
Male,_
Female-
Av.Days'
Stay
7
6
TONSILS & ADENOIDS
1
0
1
BENIGN & UNSPECIFIED
NEOPLASMS
4
3
2
1
0
9
8
7
6
5
4
5
2
1
0
■J 1 1 1 r
DELIVERIES
Age Group 6 -
Age Group 7
Age Group 8 -
Age Group 9 -
Age Group K) -
- 50-59
- 6O-64
-: 65-69
- 70-74
- 75 & over
Ay-Days'
Stay
20
18
16
14
12
10
8
6
4
2
0
16
14
12
10
8
6
4
2
0
36
33
30
27
24
21
18
15
12
9
6
3
0
1        iii? 1 r j j 1	
—
PNEUMONIA                                                                           I     _
—
1
1
/
/ —
= /
/
/
/
/             T
*        1
Jr       X**                                   #
iB>                               s s\      / -
s     *                  \         /
^    *                        \   /
; 1   wm   m
^^          ""^
—
-
-
-
—
1          II          II          II          1
-
1           II          1          1          11          1
APPENDICITIS
/\
/     \
/             X           -
_    "        t          \
_-">T                '       \  x
§■■1         1        N
-
^t^^
1          1         1         1         1         1         1         1
—
1          1        1         1         1         1         1         1
ARTERIOSCLERDTIC HEART DISEASE
-
I
-
\
-
\
-
\
-
•/
/
/                                                      _
/
-
—
_
-
-
,          1        1         1         1         1         1  1	
10
10
AGE GROUPS
 OC 18
I  BRITISH COLUMBIA
Av.Days'
Stay
25
2a r_.
AVERAGE LENGTHS OF-STAY FOR NINETEEN MAJOR DIAGNOSTIC.CATEGORIES OF ILLNESS A
FEBRUARY 1st TO OCTOBER 31st, 1953
Key to Diagnostic Categories
Infective .aod Parasitic 10 Genito-urinary System
Neoplasm?
Allergic, etc.
Blood
Mental  |j|i
Nervous System
Circulatory System
8 Respiratory System
9 Digestive
11 Deliveries, Pregnancy, etc.
12. Skin
13 Bones
14 Congenital Malformations
15 Early Infancy
16 Symptoms, Senility, etc.
17 Accidents, etc.
18 Live Births
19   jEmpairraent due to Birth Injury, etc.
15
10
1       2       y      4       5       67       8       9      10      U      12      13      14     15     16     17     18    19
Broad Diagnostic Category
A Based on Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death, 1948
 HOSPITAL INSURANCE SERVICE REPORT, 1954
CC4£>
Case '.
ity .
Fatal
Elate
14
13
12
U
pj|
9
—
8
7
6
5
4
3
2
1
0
CASE FATALITY RATES FOR NINETEEN MAJOR DIAGNOSTIC CATEGORIES OF ILLNESS ft
FEBRUARY 1st TO OCTOBER 31st, 19?3 S '
Key to Diagnostic Categories
Infective & Parasitic 10 Genito-urinary System
Neoplasms
Allergic, etc.
Blood
Mental
Nervous System
7 Circulatory System
8 Respiratory System
9 Digestive
11 Deliveries, Pregnancy, «tg.
12 Skin
13 Bones
14 Congenital Malformations
15 Early Infancy
16 Symptoms, Senility, etc
17 Accidents, etc.
18 Live Births
19 Impairment due to Birth Injury, etc.
1 I 1 ;•. .
1
234   5 "    6   7   8   9  10  11  12  13  14  15  16  17  18  19
Broad Diagnostic Category
ft Based on Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death, 1948
 CC 20
BRITISH COLUMBIA
STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR THE
FISCAL YEAR ENDED MARCH 3 1st, 1954
Revenue receipts—
THmhrn^^gmoM (neO^-   $14,001,001.38
$14,001,001.38
Cost of hospitalization re social-assistance cases    $3,868,165.51
Municipal per diem grants —     ,~ 981,481.79
Provincial per diem grants |—\ ————~      1,614,549.30
6,464,196.60
  $20,465,197.98
Cash disbursements—                                               ||p
Administration-
Salaries  ||l
Advisory Council 	
Advertising and publicity L
Tabulating equipment, rentals, etc.	
Hospital surveys  I  $3,097.37
Less recovered      9,640.76
Office supplies and general (including postage)
Office furniture and equipment	
Rentals and maintenance	
Travelling expenses 	
Upkeep of automobiles  I	
Motor-vehicles and accessories 	
$1,220,231.08
52,132.34
69,445.91
6,543.39
177,582.89
27,174.25
77,183.54
21,604.81
12,519.93
2,410.94
Payments to hospitals—claims
$1,653,742.30
24,003,800.68
$25,657,542.98
Excess of disbursements over revenue receipts for the fiscal year ended March 31st,
1954     $5,192,345.00
The Statement of Revenue Receipts and Cash Disbursements for the fiscal year 1953-54 ended
March 31st, 1954, together with the Statement Showing Cash Reconciliation with the Public Accounts
of the Province of British Columbia as at March 31st, 1954, show the cash transactions only of the
Hospital Insurance Fund for the period according to the books of the Province.
C. J. FERBER, C.A.,
Comptroller-General, Province of British Columbia.
 HOSPITAL INSURANCE SERVICE REPORT, 1954 CC 2l
STATEMENT SHOWING CASH RECONCILIATION WITH THE PUBLIC ACCOUNT*
OF THE PROVINCE OF BRITISH COLUMBIA AS AT MARCH 31st, 1954
Period ended March 31st, 1949 (Public Accounts, page
215)  $5,305,908.18
Less financed by Provincial Loans and grants—
Hospital   Insurance   Stabilization Fund         $50,000.00
"Amusements Tax Act"     1,445,573.40
     1,495,573.40
Operating receipts over disbursements |     $3,810,334.78*
Fiscal year ended March  31st,   1950,  disbursements
over receipts (Public Accounts, page 147)  $4,550,580.32
Add financed by Provincial loans and grants—
Hospital   Insurance   Stabilization Fund  $1,950,000.00
"Revenue Surplus Appropriation Act, 1950 1     2,500,000.00
$4,450,000.00
"Amusements Tax Act " (fiscal
year 1949, above)     1,445,573.40
     3,004,426.60
Operating disbursements over receipts       7,555,006.92
Fiscal year ended March  31st,   1951,  disbursements over  receipts
(Public Accounts, page 144)       5,118,697.76
Fiscal year ended March  31st,   1952,  receipts  over disbursements
(Public Accounts, page 99)  46,321.32:
Fiscal year ended March 31st,   1953,  disbursements  over  receipts
(Public Accounts, page 99)       2,207,164.18
Fiscal year ended March 31st, 1954, disbursements over receipts       5,192,345.00
Operating disbursements over receipts, 1949-54  $16,216,557.76
Add balance at March 31st, 1954—
Amount adjusted on advances to hospitals —. $2,913,592.991
Credit balance, Hospital Insurance Fund      6,489,471.92
       3,575,878.93
Less credit transferred from Vote 125, disposal of office furniture -  $5,772.69
Less credit transferred from Vote 126, disposal of motor-vehicles         20,550.00
$19,792,436.69
Credit        | 26,322.69
 $19,766,114.00
Financed by Provincial loans and grants—
Hospital Insurance Stabilization Fund—
Public Accounts, 1948-49, page 210        $50,000.00
Public Accounts, 1949-50, page 134     1,950,000.00
     $2,000,000.00
I Revenue Surplus Appropriation Act, 1950 1 (Public Accounts,
1949-50, page 134)  2,500,000.00
Amount voted under Vote 118, 1950-51   2,545,696.00
§1 "Revenue Surplus Appropriation Act, 1951 " (Public Accounts,
1950-51, page 144) |  1,500,000.00
Amount voted under Vote 124, 1951-52  2,500,000.00
Amount voted under Vote 124, 1952-53 1 -  4,686,990.00
Amount voted under Vote 144, 1953-54 -      4,033,428.00
  $19,766,114,00
* Credits.
11950-51   credits,   $1,934,062.62;    1951-52   credits,   $618,740.95;    debit   1952-53,   $44,321.56;     1953-54   credits,
M05,110.98.
 CC 22
BRITISH COLUMBIA
BENEFITS IN B.C. HOSPITALS, 1954
The general hospital services, to be provided to a qualified person pursuant to the
Act, shall include such of the following services as are recommended by the attending
physician and as are available in or through the hospital to which the person is admitted
as an in-patient:—
(a) Public-ward accommodation:
(b) Operating-room facilities, including the use of all equipment and material
required in the proper care of surgical cases:
(c) Case-room facilities, including the use of all equipment and material
required in the proper care of maternity cases:
(d) Surgical dressings and casts as required, as well as other surgical materials
and the use of any equipment which may be required while in hospital:
(e) Anaesthetic supplies and the use of anaesthesia equipment:
(/) Such drugs, prescriptions, and similar preparations as may be designated
by the Commissioner from time to time:
(g) All other services rendered by individuals who receive any remuneration
from the hospital, provided that the provision of such services in a particular hospital is approved by the Commissioner. Services which may
be approved by the Commissioner for the purpose of this clause may
include:—
ft       (i) Radiological, diagnostic, and therapeutic services, including the
services of a radiologist:
(ii) Clinical laboratory and other diagnostic procedures, including
the services of a pathologist:
(iii) The services of an anaesthetist:
(iv) Physiotherapy services:
(h) Care of the acute stage of chronic diseases where, in the opinion of the
Commissioner, such care is necessary and desirable. Such chronic diseases
shall include cardiac disease, tuberculosis, mental disease, and acute
anterior poliomyelitis; the acute stage of venereal disease only where
general hospital care is recommended by the Division of Venereal Disease
Control; the acute stage of drug addiction where overdosage and poisoning have to be given prompt treatment; and the acute stage of alcoholism,
provided in the case of acute alcoholism that hospitals establish under
their own by-laws the conditions under which such persons may be
admitted to hospital.
W ' "i||f      Emergency or Short-stay Care
Certain services are provided in addition to the in-patient benefits available to a
qualified resident or dependent. The services include emergency treatment if rendered
within twenty-four hours of being injured, and operating-room or' emergency-room
services for a minor operation which cannot be performed in a doctor's office. The
hospital charges $2 for each visit.
BENEFITS IN HOSPITALS OUTSIDE BRITISH COLUMBIA
Provided a beneficiary has not been absent from British Columbia in excess of three
months, he is entitled to payment made on his behalf at a rate fixed by the Commissioner,
in relation to the public-ward charge made by the hospital. Payment from the Hospita
Insurance Service is made only to hospitals approved by the Commissioner, and shall
not exceed $3.50 per day for new-borns and $8 per day for other beneficiaries, for a
period of time determined by the Commissioner, and in any event not exceeding thirty
days unless authorized by the Minister of Health and Welfare.
 HOSPITAL INSURANCE SERVICE REPORT, 1954
CC 23
APPROVED HOSPITALS IN BRITISH COLUMBIA
-The following hospitals are designated under the Act as hospitals required to furnish
the general hospital services provided under the Act, or such of them as are available
in the hospital:—
Armstrong and Spallumcheen Hospital, Armstrong.
Arrow Lakes Hospital, Nakusp.
Bella Coola General Hospital, Bella Coola.
Bulkley Valley District Hospital, Smithers.
Burnaby General Hospital, Burnaby.
Burns Lake Hospital, Burns Lake.
Chemainus General Hospital, Chemainus.
Children's Hospital, Vancouver.
Chilliwack General Hospital, Chilliwack.
Creston Valley Hospital, Creston.
Cumberland General Hospital, Cumberland.
Enderby and District Memorial Hospital, Enderby.
Fernie Memorial Hospital, Fernie.
Golden General Hospital, Golden.
Grace Hospital, Vancouver.
Grand Forks Hospital, Grand Forks.
Kelowna General Hospital, Kelowna.
Kimberley and District General Hospital (Mc-
Dougall Memorial), Kimberley.
King's Daughters' Hospital, Duncan.
Kootenay Lake General Hospital, Nelson.
Lady Elizabeth Bruce Memorial Hospital, Inver-
mere.
Lady Minto Hospital, Ashcroft.
Lady Minto Gulf Islands Hospital, Ganges.
Ladysmith General Hospital, Ladysmith.
Langley Memorial Hospital, Murrayville.
Lillooet District Hospital, Lillooet.
Lourdes Hospital, Campbell River.
McBride and District Hospital, McBride.
Mater Misericordiae Hospital, Rossland.
Matsqui, Sumas, and Abbotsford General Hospital, Abbotsford.
Michel Hospital, Michel.
Mission Memorial Hospital, Mission City.
Mount St. Joseph's Hospital, Vancouver.
Nanaimo Hospital, Nanaimo.
Nicola Valley General Hospital, Merritt.
Nootka Mission General Hospital, Ceepeecee.
North Vancouver General Hospital, North Vancouver.
Ocean Falls General Hospital, Ocean Falls.
Penticton Hospital, Penticton.
Pouce Coupe Community Hospital, Pouce
Coupe.
Powell River General Hospital, Powell River.
Prince George and District Hospital, Prince
George.
Prince Rupert General Hospital, Prince Rupert.
Princeton General Hospital, Princeton.
Providence Hospital, Fort St. John.
Queen Alexandra Solarium for Crippled Children, Cobble Hill.
Queen Victoria Hospital, Revelstoke.
Quesnel General Hospital, Quesnel.
Red Cross Outpost Nursing Station, Alexis
Creek.
Red Cross Outpost Nursing Station, Atlin.
Red Cross Outpost Nursing Station, Bamfield.
Red Cross Outpost Nursing Station, Blue River.
Red Cross Outpost Nursing Station, Cecil Lake.
Red Cross Outpost Nursing Station, Edgewood.
Red Cross Outpost Nursing Station, Hudson
Hope.
Red Cross Outpost Nursing Station, Kyuquot.
Red Cross Outpost Nursing Station, Lone Butte.
Rest Haven Hospital and Sanitarium, Sidney.
Royal Columbian Hospital, New Westminster.
Royal Inland Hospital, Kamloops.
Royal Jubilee Hospital, Victoria.
R. W. Large Memorial Hospital, Bella Bella.
St. Bartholomew's Hospital, Lytton.
St. Eugene Hospital, Cranbrook.
St. George's Hospital, Alert Bay.
St. John Hospital, Vanderhoof.
St. Joseph's General Hospital, Comox.
St. Joseph's General Hospital, Dawson Creek.
St. Joseph's Hospital, Victoria.
St. Martin's Hospital, Oliver.
St. Mary's Hospital, Garden Bay.
St. Mary's Hospital, New Westminster.
St. Paul's Hospital, Vancouver.
St. Vincent's Hospital, Vancouver.
Salmon Arm General Hospital, Salmon Arm.
Skidegate Inlet General Hospital, Queen Charlotte City.
Slocan Community Hospital, New Denver.
Squamish General Hospital, Squamish.
Summerland General Hospital, Summerland.
Terrace and District Hospital, Terrace.
Tofino General Hospital, Tofino.
Trail-Tadanac Hospital, Trail.
University Health Service Hospital, University
of British Columbia, Vancouver.
Vancouver General Hospital, Vancouver.
Vernon Jubilee Hospital, Vernon.
Victorian Hospital, Kaslo.
War Memorial Hospital, Williams Lake.
West Coast General Hospital, Port Alberni.
White Rock Hospital, White Rock.
Wrinch Memorial Hospital, Hazelton.
 CC 24
BRITISH COLUMBIA
CLASSES OF PERSONS COVERED BY OR EXCLUDED FROM THE
jl BENEFITS OF THE HOSPITAL INSURANCE SERVICE
A. Eligible for Benefits
A person may be classed as a | resident" for hospital insurance purposes if:—.
(a) He was living within the Province on March 31st, 1954, with the intention
of establishing his home therein and has not ceased to be a resident of the
Province since that time; or W:  'M[
(b) He is living within the Province and has lived continuously therein during
-%: the preceding twelve consecutive months; or
(c) He is living within the Province and is a dependent of a resident of the
Province; or
||| (d) He is a person who has been certified by the Deputy Minister of Welfare
to be a person entitled to health services.
A new arrival, qualifying for residence, does not disqualify himself by reason of the
fact that he was temporarily absent from the Province for a total of less than three months
during any period of twelve consecutive months. If a resident leaves British Columbia
and fails to return and resume residence within twelve months of the date of departure,
he ceases to be a resident for hospital insurance purposes and must, on re-entering the
Province, resume residence and live in British Columbia for twelve consecutive months.
A qualified dependent can be:—
(a) The spouse of the head of a family; or
(b) A child under 21 who is mainly supported by the head of a family.
A wife and dependent children arriving in British Columbia after the head of the
family assume his residential status.
|jj|i B. Excluded from Benefits
Some of the main classes of persons either permanently or temporarily excluded
from benefits are as follows:—
(a) A resident who leaves British Columbia and fails to return and re-establish
residence within twelve months; or
(b) A patient or inmate of a Provincial or Federal institution, or a person
committed to a gaol or penitentiary; or
(c) A person in a Provincial tuberculosis sanatorium; or
(d) A resident who receives hospital treatment provided under the 1 Work-
|ig|   men's Compensation Act" or the | Canada Shipping Act," or a war
veteran who receives treatment for a pensionable disability; or
(e) Persons entitled to receive hospital treatment from the Government of
Canada, or any other government; e.g., members of the armed forces, etc.
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1955
500-155-4359

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