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Sixteenth Annual Report British Columbia Hospital Insurance Service JANUARY 1 TO DECEMBER 31 1964 British Columbia. Legislative Assembly 1965

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 PROVINCE OF BRITISH COLUMBIA
HOSPITAL INSURANCE ACT
Sixteenth Annual Report
British Columbia Hospital
Insurance Service
JANUARY 1 TO DECEMBER 31
1964
  Victoria, B.C., January 21, 1965.
To Major-General the Honourable George Randolph Pearkes,
V.C., P.C., C.B., D.S.O., M.C.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
The undersigned has the honour to present the Sixteenth Annual Report of the
British Columbia Hospital Insurance Service covering the calendar year 1964.
ERIC MARTTN,
Minister of Health Services and Hospital Insurance.
 British Columbi
The Honourable E. C. Martin,
Minister of Health Services and Hospital Insurance,
Parliament Buildings, Victoria, B.C.
Sir,—I have the honour to present herewith the Report of the British Columbia
Hospital Insurance Service covering the calendar year 1964.
 DEPARTMENT OF HEALTH SERVICES AND HOSPITAL INSURANCE
British Columbia Hospital Insurance Service
The Honourable Eric Martin, Minister of Health Services and Hospital Insurance.
Senior Administrative Staff
D. M. Cox, F.A.C.H.A., F.C.I., F.C.I.S., Deputy Minister of Hospital Insurance.
W. J. Lyle, F.C.I.S., Manager, Hospital Finance Division.
J. W. Mainguy, M.H.A., Manager, Hospital Consultation and Inspection Division.
A. W. E. Pitkethley, Esq., Manager, Hospital Construction and Planning Division.
W. A. Fraser, O.B.E., E.D., M.D., CM., F.A.C.S., Medical Consultant.
K. G. Wiper, Esq., Administrative Officer.
W. D. Burrowes, B.A., Director, Research Division.
  General Introduction	
British Columbia General Hospitals (Comparisons of Growth)—
The Hospital Insurance Act ■.	
The Hospital _c__§_2J	
Persons Entitled to or Excluded from the Benefits under the Hospital Insurance
Entitled to Benefits	
Excluded from Benefits	
Hospital Benefits Available in British Columbia...
In-patient Benefits : _apr;wateis_
Emergency Services and Minor Surgery__
Application for Hospital Insurance Benefits.—
The Hospital Rate Board and Methods of Payment tc
Organization Chart j	
Organization and Administratii
Hospital Finance Division...
Hospital Accounting	
Hospital Construction and Planning Divisioi
Hospital Projects Completed during 1964 .	
Hospital Projects under Construction at Year-end...
Projects in Advanced Stages of Planning
Additional Projects Developed through Various Planning Si
' Hospital Consultation and Inspection Division	
Medical Consultation Division	
Administrative Officer . .	
Third Party Liability Section :	
Eligibility Inspectors' Section	
Research Division * .	
Public Information	
General Office	
Hospitals as Defined under the Hospital Insurance Act-
Public Hospitals	
Private Hospitals (Providing General Hospital Services)_
Rehabilitation, Chronic, and Convalescent Hospitals	
 BRITISH COLUMBIA
Statistical Data : : 5
Table I.—Patients Separated (Discharged or Died), Total Patient-days
and Proportion Covered by British Columbia Hospital Insurance
Service, British Columbia Public Hospitals Only, 1949-64 (Excluding
Federal, Private, and Out-of-Province Hospitalization)   (Including
Rehabilitation Hospitals)   3
Table IIa.—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, 1949-64 (Including Rehabilitation Hospitals) 4
Table _b.—Summary of the Number of B.C.H.I.S. In-patients (Including
Rehabilitation Patients) and Short-stay Patients, 1949-64  4
Table HI.—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 1964 (Including
Rehabilitation Hospitals) . __ 4
Table IV.—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 1964 (Including Rehabilitation Hospitals) 4
H.—Percentage Age Distribution of Male and Female Hospital Cases and
Days of Care, 1963 .  4
« by Type of Clinical Service,
V.—Average Length of Stay of Cases in Hospitals in British Columbia by
Major Diagnostic Groups, 1963 (Excluding Newborns) 47
 Sixteenth Annual Report of the British Columbia
Hospital Insurance Service
INTRODUCTION
Donald M. Cox, F.A.C.H.A., Deputy Minister of Hospital Insurance
The British Columbia Hospital Insurance Service completed its 16th year of
operation on December 31, 1964. During the year, payments to hospitals were
at an all-time high, and the Province's vast programme of hospital construction,
initiated at the community level and stimulated by generous Provincial grants,
proceeded without let-up. This continued progress and development in the British
Columbia hospital field has been made possible through the combined efforts of
Government and hospital organizations, and the generosity of the residents of the
areas concerned, who contribute to the provision of local funds required in the
financing of hospital construction.
The four main functions carried out since the inception of the Service on
January 1, 1949, have been to safeguard the residents of the Province from the
financial burden associated with hospitalization; to enable hospitals to improve
services by assuring them of a steady income; to assist communities in providing
adequate facilities by administering the grant-in-aid programme; and to help
hospitals establish and maintain high standards of patient-care by providing professional consultative services.
Tn 1964 an estimated $68,300,000 was paid to hospitals on behalf of 329,200
individual hospital accounts. In 1949 the daily payment of hospital accounts made
by the British Columbia Hospital Insurance Service to British Columbia hospitals
was $50,000; daily payments in 1964 averaged over $185,000. At the present
time approximately 95 per cent of all patients in the Province's acute-care general
and rehabilitation hospitals receive coverage from the British Columbia Hospital
Insurance Service. The remaining 5 per cent are primarily non-residents, workmen's
compensation recipients, armed forces personnel, and veterans with pensionable
disabilities.
In addition to the financial aid extended to hospitalized residents, Provincial
grants for hospital construction and equipment purchases have amounted to over
$40,000,000. The Provincial Government pays 50 per cent of the approved costs
of acute and rehabilitation hospital construction; one-third for buUding improvements, renovations, and equipment; and one-third the cost of nursing-home-type
beds built by non-profit organizations. In 1964, 11 major projects were completed,
involving 345 beds and gross construction costs of $4,400,000. Included in these
completed projects were new hospitals and nurses' residences at Merritt, Fort Nelson,
and Sechelt; additions and renovations at Quesnel; completion of unfinished areas
at Dawson Creek; a 152-bed nurses' residence and training-school at Kamloops;
a mechanical wing at Vernon; and a new laundry and maintenance building for the
Royal Columbian Hospital in New Westminster.
As the year drew to a close, additional projects costing $11,000,000 were under
way at Murrayville, Mission, Kamloops, North Vancouver, Richmond, and Victoria.
 K 10 BRITISH COLUMBIA
A great many projects were still at various stages of planning on draughting-boards
throughout the Province, as numerous areas of the Province continue to ensure the
provision of adequate hospital facilities for many months to come. A detailed
summary of hospital construction appears elsewhere in this Report.
During the year, arrangements were made to ensure that hospitals were provided with funds to enable them to pay for the professional interpretation of electrocardiograms for in-patients. Similar arrangements were made for those hospitals
providing electroencephalograms. The Hospital Insurance Service was also authorized to accept the basic cost of Professional Activity Study (P.A.S.) from January 1,
1964. This service can be of considerable value to the medical staff and hospitals
in respect to the evaluation of patient-care and medical records. P.A.S., if adopted
by all hospitals in the Province, would cost approximately $100,000 per year.
The Service was most appreciative of the continued advice and assistance
given by the medical association throughout the year. By arrangement, inquiries
made by the Service regarding the continued development of the rehabilitation
programme, and other medical matters, are directed to the executive director of the
Canadian Medical Association (British Columbia Division) and referred by him
to the appropriate committees or sub-committees. I should like to again record
my appreciation of the assistance rendered by that association, the College of Physicians and Surgeons of British Columbia, and by the medical profession generally.
As in previous years, the work of the Laboratory and Radiological Advisory
Councils was of inestimable value in assisting hospitals to improve their laboratory
and radiological services, and in advising the Service on requests for Provincial
grants-in-aid on the purchase of major equipment.
Effective May 1, 1964, the management of the Provincial Infirmaries was
transferred to the Health Branch in accordance with the Government's decision to
utilize the available beds in Pearson Hospital, Vancouver, for the use of Provincial
Infirmaries patients.
Finally, I should like to express my personal thanks to the staff of the Hospital
Insurance Service in general, and to the division managers in particular, for the
manner in which they carried out then additional duties and responsibilities during
my absence. I should also like to express my appreciation for the many kindnesses
and courtesies extended me by the executive of the British Columbia Hospitals'
Association.
Reports prepared by the various divisions on work undertaken during 1964
appear under " Organization and Administration."
 HOSPITAL INSURANCE SERVICE, 1964
B.C.H.I.S. Payments to Hospitals
Hospitals' Growth Rate
*o^\
^S
.!_-
$jjt
/
„WI
ST4FF
/
"   PATENT   PAY
g^___L-__
\   \   1
Percentage Increase o
Total gross expenditure (excluding depreciation)
Staff (full-time equivalent)
...    344
Population
 K 12
BRITISH COLUMBIA
Total Full-time Staff and Average Number of Patients
(Adults and Children) per Day
j
11    ^
e(,tJxr^_^-
«^«as-
Avr««f   '
_ " """^
Gross Salaries and Wages and Other Operating Expenses*
•'?"[
35 _
ti^s
___^-__^
/^
Cy.r£»ie
.«r«*j£.
'
57                          1960                          ,
 HOSPITAL INSURANCE SERVICE, 1964 K 13
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.
Its main provisions 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 and rehabilitative 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 maximum period of three months, if they
are admitted to an approved hospital within the first three months following their departure from the Province.
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 this
Statute.
The Hospital Act controls the organization and operation of hospitals, which
are classified as follows:—
(1) Public hospitals—non-profit hospitals caring primarily for acutely ill
persons.
(2) Private hospitals.   This category includes:—
(a) Small general hospitals, most of which are operated in remote
area's by industrial concerns primarily for their employees.
(b) Nursing homes, most of which are operated for profit by private
operators or companies. Several are operated as non-profit organizations
by religious and other groups.
(3) Rehabilitation, chronic, and convalescent hospitals—these are non-profit
hospitals approved under Part HI of the Hospital Act, primarily for the
treatment of persons who will benefit from intensive rehabilitative 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 proves to the satisfaction of the Deputy
 K 14 BRITISH
Minister of Hospital Insurance 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 total of one month 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
Excluded from Benefits
Some of the main classes of persons either permanently or temporarily excluded
from benefits are as follows:—
(a) A person who works full or part time in British Columbia but who resides
outside the Province; or
(b) A resident who leaves British Columbia temporarily and fails to return
and re-establish residence within 12 months, or who establishes his home
elsewhere;   or
(c) An inmate of a Federal penitentiary; or
(d) 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
(e) 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.
HOSPITAL BENEFITS AVAILABLE EN" BRITISH COLUMBIA
In-patient Benefits
In addition to standard-ward accommodation with meals and necessary nursing
services, a beneficiary may receive any of the other services available in the hospital,
which may include:—
Laboratory and X-ray services.
Drugs, biologicals, and related preparations (with a few exceptions).
Use of operating-room and caseroom facilities.
Use of anaesthetic equipment, supplies, and routine surgical supplies.
Use of radiotherapy and physiotherapy facilities where available.
Other approved services rendered by employees of the hospital.
(Note.—Private or semi-private rooms cost more to maintain than standard
wards, and the patient is required to pay extra for such accommodation if it is
requested by the patient or ordered by his physician.)
Emergency Services and Minor Surgery
The following benefits are also provided in British Columbia public hospitals
to beneficiaries who do not require in-patient care:	
 HOSPITAL INSURANCE SERVICE, 1964 K IS
Emergency treatment within 24 hours of being accidentally injured.
Operating-room or emergency-room services for minor surgery, including
application and removal of casts.
The hospital charges beneficiaries $2 for each visit, and the remainder of the
cost is paid by the British Columbia Hospital Insurance Service.   However, if the
patient received treatment from a private physician, he is responsible for paying the
doctor's services, as such charges are not payable by the British Columbia Hospital
Insurance Service.   Non-beneficiaries are required to pay the full hospital charge
for such services.
APPLICATION FOR HOSPITAL INSUTcANCE 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 denned
in the Hospital Insurance Act and regulations. Payment of the account 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 HOSPITALS
The Hospital Rate Board, appointed by Order in Council in January, 1951, is
composed of the Deputy Minister of Hospital Insurance, the Hospital Finance Manager, and the Hospital Consultation and Inspection Manager. The purpose of the
Board is to advise the Deputy Minister in regard to the rates of payments to hospitals.
A system of firm budgets for hospitals, which has been in use since January 1,
1951, provides for a review of hospitals' estimates by the Rate Board. Under the
firm-budget procedure, hospitals are required to operate within their approved
budgets, with the exception of fluctuation in days' treatment and other similar items.
They are further advised that deficits incurred through expenditures in excess of the
approved budget will not be met by the Provincial Government. The value of variable supplies used in patient-care has been established. It is generally recognized
that the addition of a few more patient-days does not add proportionately to patient-
day costs, because certain overhead expenses (such as heating, etc.) are not affected.
However, some additional supplies will be consumed, and it is the cost of these
variable supplies which has been determined. When the number of days' treatment
provided by the hospital differs from the estimated occupancy, the budgets are
increased, or decreased, by the number of days' difference multiplied by the patient-
day value of the variable supplies. Individual studies and additional budget adjustments are made in those instances where large fluctuations in occupancy involve
additions or reductions in stand-by costs.
Over 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. Nonqualifying residents are charged the hospitals' established per diem rates, which are
 K 16 BRITISH COLUMBIA.
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.
 HOSPITAL INSURANCE SERVICE, I
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 K 18 BRITISH COLUMBIA
ORGANIZATTON 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.
In June, 1964, Mr. Cox was singularly honoured by his election to the newly
appointed Council of Regents of the American College of Hospital Administrators.
The Council is the policy-making body of the college, and one regent is elected from
each Province in Canada and each State in the United States. He was further
honoured in September at the Western Canada Institute of Hospital Administrators
and Trustees, when the British Columbia Hospitals' Association presented him with
a certificate of appreciation for his efforts as organizer and chairman of the first
institute, held in 1945.
The following reports give a brief outline of the work carried out during 1964
by the various divisions and offices which comprise the administrative structure of
this branch.
Hospital Finance Division
W. J. Lyle, F.C.I.S., Manager
Hospital accounting and payment of hospital claims are the two main functions
of the Hospital Finance Division. The Division is also responsible for the approval
of equipment grants, and in 1964, after a review of 3,700 applications received from
hospitals, it paid grants of approximately $700,000 on equipment costing $2,100,-
000. During 1964 the Division Manager attended two meetings in Ottawa of the
Advisory Council on Hospital Insurance and Diagnostic Services, which is the
advisory body to the Minister of National Health and Welfare. The Manager also
acted on a sub-committee on finance and accounting which was given the task of
studying and making recommendations relative to the sharing of certain costs under
the Federal-Provincial agreement.
Close liaison was continued between the Division Manager and the <_ommis-
sioner 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 to represent the British Columbia Hospital Insurance Service on the Radiological Advisory Council, which acts in an advisory
capacity on the development of radiology services and the purchase of equipment
by public hospitals. He also participated in meetings of the Advisory Committee
on Medical Radiography, which was appointed to assist in the development plans
for the new Institute of Technology being constructed in Burnaby.
In April, 1964, the former Supervisor of Hospital Accounting, Mr. G. L.
Morris, C.A., retired because of illness, and the former Assistant Supervisor, Mr.
L. A. Yeomans, C.A., was superannuated on reaching retirement age. Mr. Morris
joined the Hospital Insurance Service in November, 1948, and Mr. Yeomans joined
shortly after, in September, 1949. They will both be missed, not only for their
many years of valuable experience, but also for their guidance and leadership.
Mr. J. Butcher was selected in July to succeed Mr. G. L. Morris, but unfortunately
found it necessary for health reasons to submit his resignation, effective December
31, 1964.
 HOSPITAL INSURANCE SERVICE, 1964 K 19
Hospital Accounting
J. Butcher, C.G.A., Supervisor
The work of the Hospital Accounting Section falls into two main categories:
(a) the detailed inspection, in the field, of the financial records of the hospitals for
purposes of verification of annual and other financial statements, and (b) the
assembly of relevant information, and preparation of tabulations and other data, for
use by the Hospital Rate Board in its reviews of hospitals' estimates. In carrying
out the inspection duties, visits were made at least once during 1964 to 87 public
general hospitals and four public rehabilitation hospitals, the individual visits extending from three days to four weeks. The gross expenditures of these public general
and rehabilitation hospitals, as approved by the Hospital Rate Board, for the year
1964 amounted to $73,000,000.
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.
(„) 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 1964, construction projects, involving expenditures of $7,100,000,
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.
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.
 K 20 BRITISH COLUMBIA
Under the terms of the Federal Hospital Insurance and Diagnostic Services
Act, whereby the Federal Government shares in the costs of in-patient care in this
Province, monthly payments are made to the Province by Ottawa, based on advances
to hospitals made by the Province during the previous month. These payments are
later taken into account when the total amount payable by the Federal Government
is determined for the calendar year. The final calculation for the year is based on
the annual audited financial reports of each public hospital, after the hospital's
records have been inspected by accountants from this Section and approved by
Federal Treasury auditors. Compilation of the necessary data required by the
Federal authorities for purposes of the final settlement is highly complex, and involves a considerable amount of detailed work before agreement on the amount
shareable in respect of each financial year is reached.
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
W. J. Wade, Supervisor
The Hospital Claims Section is responsible for processing Admission/Separation Records (accounts), which hospitals submit for each patient, and approving
for payment all acceptable claims. Every claim is checked by this office, whether
it is payable by the British Columbia Hospital Insurance Service, by the patient, or
other agency. The year 1964 required increased production as approximately 1,400
claims and an average of over 500 emergency-service or minor-surgery account
forms were processed during each working-day.
In addition to the normal processing of hospital claims, the planning and
reviewing of procedures was continued during the year, in order to meet the increasing volume and complexity of handling claims. Several pages of the B.C.H.I.S.
manual were revised, and some forms were modified to bring them up to date.
Discussions with the Bureau of Statistics were continued regarding efficient use of
the I.B.M. electronic data-processing equipment.
A brief outline of the work and duties performed by the various sections of
Hospital aaims follows.
The Admission Control Section reviews each Application for Benefits made by
patients who claim to be qualified for benefits under the Hospital Insurance Act.
Details of residence are checked with the verifying documents, and the discrepancies
are referred back to the hospital or the EUgibility Inspectors. Over 5,400 hospital
claims, or some 1.5 per cent of the total received from hospitals, were returned for
further information. Advice and assistance were given to hospital admitting staffs
on the proper methods of obtaining and recording the patient's residence information
and employment history. This was carried out by correspondence, by actual visit
to the hospital, or by attendance at hospital regional meetings.
The Accounts Payment Section verifies the charges made to the British Columbia Hospital Insurance Service, and ensures that all information shown on each
claim is completed for statistical purposes, and that it is charged to the correct
agency, such as the British Columbia Hospital Insurance Service, Workmen's
Compensation Board, Department of Veterans Affairs, or other Provinces and
Territories. During the year an average of 500 queries per month on accounting
matters was addressed to British Columbia hospitals. In 1964 a total of 325,425
 1 was paid, compared to 319,539 in 1963 and 311,543 in 1962.
 HOSPITAL INSURANCE SERVICE, 1964 K 21
The Social Welfare Records Section continues to maintain the alphabetical
file of all Health Services Identification Cards issued to welfare recipients in this
Province. Over 21,000 hospital accounts incurred by welfare recipients were
checked to this file to determine eligibility for hospital benefits. This file is also
used by the Department of Social Welfare as a source of information. During the
year, Health Services Identification Card duplicates were received for new recipients
of social welfare in British Columbia, which increased the number of cards filed
to over 90,000.
The Voucher and Key-punch Sections are responsible for batching and voucher-
ing 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 also used to tabulate
remittance listings of payments due to hospitals.
The Out-of-Province Section handles all claims for hospital accounts incurred
by British Columbia residents in hospitals outside the Province. This includes
establishing ehgibility and the payment of claims. During 1964 a total of 3,855
accounts, amounting to $684,950, was paid on behalf of qualified residents who
were hospitalized in the other Provinces and Territories of Canada, and the continental United States, including Alaska and Hawaii; Australia; Austria; Belgium;
Bermuda; Denmark; England; France; Holland; Italy; Ireland; Jamaica; Japan;
Kenya; Mexico; The Netherlands; New Zealand; Portugal; Scotland; Switzerland;
Uganda; and West Germany. Correspondence arising from all out-of-the Province
accounts totalled 15,170 letters and forms.
This Section also compiles up-to-date hospital rate schedules for every approved
hospital in Canada.
The Filing Section sorted and filed an average of 4,100 documents and letters
daily, an increase of 150 daily over last year. With the elimination of obsolete
documents stored since 1954, space was made available for the annual storage of
documents so that original copies are now available. No further microfilming was
undertaken, resulting in a considerable saving in expenditure.
Hospital Construction and Planning Division
A. W. E. Pitkethley, Manager
The primary responsibilities of this Division may be summarized as follows:—
(1) Working with hospital boards of management and hospital construction
planning committees in the development of programmes for the construction of new hospital facilities, additions to and renovation of existing hospitals, and residence accommodation for hospital personnel.
(2) Providing full consultative services to hospitals planning projects outlined
above, and recommending such programmes for approval.
(3) Processing and recommending for approval applications for Provincial
grant assistance toward capital improvement and renovation projects.
The Division also initiates applications for Federal construction grants,
and processes and submits claims for payment.
Special emphasis is given to the need for the development of written programmes for proposed construction projects. Hospitals are assisted by this Division
in the preparation of such programmes, which provide architects and their engineering consultants with basic planning criteria for the logical development of plans.
A great deal of time is spent in reviewing plans of proposed building projects.
Special attention is given to the interrelationship of the various departments of the
 K 22 BRITISH COLUMBIA
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 for future expansion.
During the year, liaison was maintained with the mechanical engineering
profession, in recognition of the need to design high-quality mechanical systems that
would make a maximum contribution toward an efficient and economical hospital
operation. Some of the elements included in designs for mechanical systems for
new hospital buildings that reflect this approach include heat recovery systems, air
recirculation, and zoned heating and ventilating controls. Liaison was also maintained with the Hospital 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. Hospital boards are provided with a complete consultative planning
service through this Division, and through the co-operation of Health Branch personnel, members of the medical and nursing profession, and other divisions of the
British Columbia Hospital Insurance Service. The Provincial Health Branch renders
assistance through the Division of Public Health Engineering, the Nutrition Consultant, the Technical Supervisor of Clinical Laboratory Services, the Technical
Supervisor of Radiology, and the Provincial public health officers. Hospital plans
are also referred for review and comment by the Chief of the Hospital Design Division, Department of National Health and Welfare, Ottawa. The Construction and
Planning Division maintained liaison with the Faculty of Medicine of the University
of British Columbia.
Continuing benefit was derived through the co-operation of the Public Works
Department by assigning architects to this Division. During the year a second
architect was assigned on a full-time basis.
With the additional architectural assistance available, it has been possible to
prepare detailed sketch plans in support of layouts representing the Division's recommended approach to planning problems. It has been found advantageous to follow
this procedure on small complex projects, where it is easier to develop detailed
sketches than to embark on lengthy time-consuming review procedures. Under such
circumstances the usual portion of architectural fees relating to sketch drawings
would not be charged by the hospital's architect, whose responsibilities would include
the preparation of working drawings, and supervision during construction.
During 1964 the Manager of the Division served on two Federal working
*' *s participated in panel discussions, addressed a B.C.H.A. regional council
ig, and made inspectional visits to several hospitals. Details regarding these
follow.
He continued to serve on the two working parties established under the
chairmanship of the Chief of the Hospital Design Division, Ottawa. The working
parties were established with a view to studying and developing construction standards for the chronically ill, and also to revise and expand the general hospital
construction standards originally published in 1948.
He attended meetings of the Hospital Area Planning Group (New Westminster
and surrounding municipalities) held at the Surrey Memorial Hospital. This group
was formed early in 1963 in order that common problems relating to the future
roles of the hospitals in the area may be discussed on a co-operative basis.
He was also a member of a panel discussing the subject " The Care of Prematurely Born Infants " at a course sponsored by the University of British Columbia,
Department of Paediatrics, on January 20th, 21st, and 22nd at Vancouver.
 HOSPITAL INSURANCE SERVICE, 1964 K 23
The subject " Regional Planning " was presented by the Division Manager at
the first meeting of 1964 of the Lower Mainland Regional Council of the British
Columbia Hospitals' Association, held on February 3rd in St. Vincent's Hospital
auditorium. The meeting was attended by administrators, members of boards of
trustees, and members of medical staffs.
In order to be familiar with some of the possible computer applications that
might be considered for the proposed new teaching hospital facility at the University
of British Columbia, he visited hospitals in Akron, Ohio, and Washington, D.C.,
and heard papers on the subject at the American Hospital Convention in Chicago
during September, 1964.
On October 5, 1964, the Division Manager addressed the West Kootenay
Regional Council meeting held at Nakusp. The topic of the address was " Regional
Planning." Later a meeting was held in Victoria with representatives of the hospitals
in the New Westminster-Surrey-White Rock region, and discussions were held with
an official of a New York firm of laundry managerial consultants to determine the
feasibility of an efficiency survey by the firm in that area.
The Manager of the Division and his staff made a series of inspection trips to
hospitals in British Columbia, including facilities in Vancouver and the Fraser Valley
areas, the Kamloops and Okanagan areas, the Trail-Castlegar and the Merritt-Lytton
areas, as well as Vancouver Island.
(a) Hospital Projects Completed during 1964
Royal Inland Hospital, Kamloops—Nurses' Residence and Training-school.—
The new residence and training-school came into operation in the fall of this year.
The residence provides accommodation for 108 student nurses in single and double
bedrooms. The first floor is devoted to teaching facilities, the remaining five floors
for nurses' accommodation. The building is of reinforced concrete with the exterior
a combination of brick veneer and painted concrete.
Nicola Valley General Hospital, Merritt.—The Minister of Health Services
and Hospital Insurance officially opened the new hospital at Merritt on March 21,
1964. The new 37-bed reinforced-concrete two-story hospital replaces the old
hospital, which was constructed in 1911. The new hospital provides facilities for
a full range of acute patient-care. There is a partially finished area in the structure which, when completed, will increase the bed capacity by eight. A separate
residence to accommodate eight nurses was also constructed on the hospital-site.
Fort Nelson General Hospital.—On June 15, 1964, the Minister of Health
Services and Hospital Insurance officially opened the new hospital building at Fort
Nelson. The hospital opened with a capacity of 33 adults' and children's beds, and
provision is also included for future expansion. There is accommodation for 8
nurses' beds in the hospital building. The Fort Nelson General Hospital is British
Columbia's most northerly hospital.
Vernon Jubilee Hospital.—The new boiler plant and laundry building was
completed in June, 1964. This project is the first phase in an expansion programme planned for the hospital.
G. R. Baker Memorial Hospital, Quesnel.—On July 29, 1964, the Minister
officiated at the formal opening ceremonies for the hospital's new facilities. The
building project included additions to the existing buildings to provide 36 beds,
plus unfinished space for 22 future beds. The additions also included space for
three labour beds, an enlarged emergency department, an enlarged laboratory,
plus physiotherapy department, pharmacy storage and general storage, etc.
 K 24 BRITISH COLUMBIA
St. Joseph General Hospital, Dawson Creek.—la April, 1964, the previously
unfinished area on the top floor of the building was completed and brought into
operation. The additional beds located on the top floor increased the capacity of
the hospital to a total of 100 adults' and children's beds.
St. Mary's Hospital, Sechelt.—The. Minister of Health Services and Hospital
Insurance officially opened the new hospital on November 29, 1964. The new
building will replace the old hospital located at Garden Bay. The new hospital is a
single-story reinforced-concrete building with provision for 35 beds. A 13-bed
nurses' residence was included in the construction project.
(£>) Hospital Projects under Construction at Year-end
St. Joseph's Hospital, Victoria—Phase 2 of Construction Programme.—This
phase includes construction of an addition for a new linen service department and
morgue, dietary department renovations, a new electrical distribution system, renovations and improvements to the administrative areas and the emergency department, applying brick facing to the exterior wall surfaces of the hospital buildings,
plus additions to the sisters' quarters.
Royal Inland Hospital, Kamloops.—Construction of an addition to provide
152 beds, plus an unfinished floor for future requirements.
Menno Private Hospital, Abbotsford.—An addition to provide some 39 beds,
plus other renovations.
Mission Memorial Hospital, Mission City.—Construction of a new 54-bed
hospital, plus unfinished space for approximately 24 beds.
Royal Columbian Hospital, New Westminster.—Construction of an addition to
house the emergency department.
Lions Gate Hospital, North Vancouver.—Conversion of the old North Vancouver General Hospital building for psychiatric and activation care.
Tofino General Hospital, Tofino.—Construction of an addition for 4 beds,
plus unfinished space for 2 additional beds.
Richmond General Hospital, Richmond.—Construction of a new hospital
facility to provide 132 finished beds, plus 22 beds in unfinished areas.
Langley Memorial Hospital, Murrayville.—Construction of a new 81-bed hospital, plus space for 24 beds in partially finished areas as well as a top floor in
" shell" form only of approximately 37 beds.
(c) Projects in Advanced Stages of Planning and for Which Working Drawings
Are Completed or Are in Process of Preparation
Cowichan District Hospital, Duncan.—New hospital building.
Lady smith and District General Hospital.—Addition and renovations.
St. Joseph's General Hospital, Comox.—New hospital building.
100 Mile House.—New hospital facility.
Mater Misericordice Hospital, Rossland.—Addition and renovations.
Gorge Road Hospital, Victoria.—Addition for physical medicine department.
Boundary Hospital, Grand Forks.—Nurses' residence.
(d) Additional Projects Developed through Various Planning Stages in 1964
Vernon Jubilee Hospital.—Additions and renovations.
Prince Rupert General Hospital.—Addition and alterations.
Kelowna General Hospital.—Additions and renovations.
Creston Valley Hospital.—Addition and improvements.
 HOSPITAL INSURANCE SERVICE, 1964 K 25
Health Sciences Centre, University of British Columbia.—New hospital
building.
Vancouver General Hospital.—Replacement of Laurel Pavilion.
Peace Arch District Hospital, White Rock.—Addition.
Cariboo Memorial Hospital, Williams Lake.—Nurses' residence.
Bulkley Valley District Hospital, Smithers.—Addition.
Trail-Tadanac Hospital.—Additions and renovations.
Summerland General Hospital.—New hospital.
Holy Family Hospital, Vancouver.—Addition.
Cranbrook and District Hospital.—New hospital and nursing home.
Maple Ridge Hospital, Haney.—Expansion.
Ocean Falls General Hospital.—Replacement.
Pouce Coupe Community Hospital.—Addition for nursing home.
Queen Victoria Hospital, Revelstoke.—Replacement.
G. F. Strong Rehabilitation Centre, Vancouver.—Addition and renovations.
Children's Hospital, Vancouver.—Planning only.
St. John Hospital, Vanderhoof.—Renovation.
Surrey Memorial Hospital.—Expansion programme.
Castlegar and District Hospital.—Expansion.
Royal Inland Hospital, Kamloops.—Renovations.
Royal Columbian Hospital New Westminster.—Conversion of existing space
for new laboratory.
Royal Columbian Hospital, New Westminster.—Expansion.
St. Mary's Hospital, New Westminster.—Expansion.
West Coast General Hospital, Port Alberni.—Completion of space, plus renovations and nursing-home facilities.
Prince George Regional Hospital.—Construction of fourth- and fifth-floor
addition.
Squamish General Hospital.—Renovations and improvements.
Mills Memorial Hospital, Terrace.—Expansion.
Royal Jubilee Hospital, Victoria.—Laboratory expansion.
Powell River General Hospital.—Nursing home.
Nanaimo Regional General Hospital.—Nursing home.
King's Daughters' Hospital, Duncan.—Nursing home.
  , ¥i9iwtm!rirnar\     -°«w_ %f._ /f ,_Tr_____-^7,|W/
1
B_L*___P\_X E
 BRITISH COLUMBIA
MAJOR HOSPITAL PROJECTS COMPLETED
OR UNDER CONSTRUCTION
IN 1964
COMPLETED
iwson Creek:   Unfinished
on top floor.
imloops:   New  108-bed n
The new 37-bed Nicola Valley General Hospital, Mer-
on March 31, 1964.
i _l
^_^__^_^^____a___ii
_I___B
UNDER CONSTRUCTION
Murrayville: New 81-bed hospital.
i (St. Joseph's):   Phase 2
 HOSPITAL INSURANCE SERVICE, 1964 K 29
Hospital Consultation and Inspection Division
J. W. Mainguy, M.H.A., Manager
The work of this Division is concerned with both public and private hospitals.
A consultative service is provided to all hospitals on problems of administration and
operation in all aspects of management. The Division is also responsible for the
licensing and inspection of private hospitals, including both private acute hospitals
(all but one of which are operated in remote areas of the Province by industrial
companies) and private hospitals giving nursing-home care to the aged sick. Most
of the latter kind are privately owned and operated for profit.
. The Division works with the Finance Division in analysing hospital estimates,
including pre-construction estimates for projects being planned, and the Manager
is a member of the Rate Board. Hospital society by-laws are reviewed with the
Administrative Officer, and advice is given to hospitals on setting up suitable medical-
staff by-laws, rules, and regulations. Hospitals are encouraged to work toward
accreditation by the Canadian Council on Hospital Accreditation, which gives
recognition to those hospitals which meet prescribed standards of care and management. During 1964 the consultants of the Division made 56 visits to public
hospitals, most visits requiring from one to three or more days in the hospital,
and sometimes needing more than one member of the staff.
Working with the Provincial Fire Marshal and other safety officers, the staff
of the Division checked hospital standards of safety and fire precautions.
The Division Manager continued to serve as the B.C.H.I.S. representative on
the Laboratory Advisory Council, which advises the Government on the develoD-
ment of laboratory services in public hospitals, including setting up regional pathology services, the appropriate selection of equipment, and the ttaining of laboratory
technologists. With the advice of the council, seven regional services have been
approved, of which six are now in operation, a pathologist having been secured by
the north-east region during the year.
The Division frequently works in conjunction with the Health Branch. Contact
was maintained during the year with the medical health officers, the Technical Supervisor of Clinical Laboratory Services, and the Technical Supervisor of Radiology,
who also visit hospitals to provide advice and assistance in respect of the work of
these two departments. The Health Branch Nutrition Consultant also assisted the
Division in giving advice on dietary problems to both public and private hospitals.
The Division continued to work with the Director of Emergency Health Services
and the Provincial Civil Defence authorities. Two more hospital disaster institutes
were held during the year—one at Nelson for hospitals in the Kootenay District
and one at Prince George for hospitals in the northern area of the Province. These
were two-day institutes attended by administrators, directors of nursing, and medical-
staff representatives from hospitals in the area. Their purpose is to encourage each
hospital to prepare a written plan for dealing with all kinds of unexpected emergencies. This Division was represented on the Provincial Hospital Disaster Plan Review
Committee, along with members from the Health Branch and Provincial Civil
Defence. This committee is responsible for reviewing disaster plans submitted by
hospitals and approving them for the issue of Federal disaster supply kits.
The Manager of the Division continued as a member of the Sub-committee on
Quality of Care, Research and Statistics and on the Working Party on Hospital
Standards, both convened by the Department of National Health and Welfare.
Members of the Division also represented the Service by providing liaison with
several committees of the Registered Nurses' Association and the British Columbia
 K 30 BRITISH COLUMBIA
Hospitals' Association. A member of the Division sat with the sub-committee of
the Medical Advisory Committee which studied the needs for rehabilitation facilities
in the Greater Vancouver area.
With keen co-operation from the hospital, the Division initiated a study of
nursing-service functions at the Surrey Memorial Hospital, in conjunction with
consultants of the Department of National Health and Welfare and the Research
Division of the Hospital Insurance Service. The results of the study will be available
early in 1965.
The number of beds in private acute hospitals remained at 76 beds in five
hospitals, four of which are operated by industrial concerns.
During the year, 130 visits for consultation and inspection were made to private
hospitals giving nursing-home care. This figure does not include visits related to
the construction of new private hospitals.
In 1964, licences were issued to the following newly constructed private
hospitals:—
Simon Fraser Private Hospital, Prince George (75 beds).
Amherst Private Hospital, Vancouver (75 beds).
Normandy Private Hospital, Vancouver (75 beds).
Inglewood Private Hospital, West Vancouver (75 beds).
Sandringham Private Hospital, Victoria (75 beds).
Willingdon Private Hospital, Burnaby (75 beds).
Fellburn Private Hospital, Burnaby (75 beds).
Richmond Heights Private Hospital, Saanich (75 beds).
One private hospital with 19 beds closed during the year, and the capacity of
another was reduced by 3 beds. In addition to the new hospitals mentioned above,
the capacity of one hospital was increased from 52 to 75 beds. This means that
there are now 74 licensed private hospitals giving nursing-home care in the province,
with a total of 3,311 beds, an increase of 601 beds over the total at the end of 1963.
Four more private hospitals were under construction at the year-end, which will.
increase the total beds available by a further 249 beds. One other private hospital
will be increasing its capacity from 36 to 75 beds, and five more proposed hospitals
in the planning stage will, if approved, provide a further 335 beds in the Province.
During the latter part of the year the Minister gave his approval-in-principle
to the development of nursing-home units by several general hospitals.
This Division, together with the Research Division, participated with the
Department of Rehabilitation Medicine at the University of British Columbia in
a survey conducted by Dr. Doris E. Mackay, specialist in physical medicine and
rehabilitation, of a sample of 501 patients in nursing homes in Vancouver and
Victoria to assess the kind of care needed by patients in these hospitals.
In March of this year the Division organized a three-day institute in Vancouver
for private hospitals, which was sponsored by the Department of Health Services
and Hospital Insurance. With the help of many outside specialists, this educational
programme was devoted to the care of the patient, with particular emphasis on
increased activity programmes to restore patients to their maximum possible physical
capabilities for as long as possible, so as to make life more enjoyable for the older
people who make up most of the patient population in these hospitals. The institute
was attended by representatives of 55 private hospitals.
Detailed inquiries about the requirements for obtaining a licence to operate
a private hospital were made to the Division during the year by 124 persons or
groups.
 r
HOSPITAL INSURANCE SERVICE, 1964 K 31
Under the Hospital Act, no person may act as superintendent of a private
hospital without the approval of the Chief Inspector. The Registered Nurses'
Association has continued to assist the Division in screening the credentials of
prospective superintendents.
An associated responsibility of the Division is to arrange for the placement,
by the Social Welfare Department, of welfare patients who no longer need to remain
in acute general hospitals but must be admitted to nursing homes because their
needs are beyond what could be provided in their own homes. This service is
provided only on the request of an acute hospital, and 106 cases were dealt with
under this arrangement during the year.
Medical Consultation Division
W. A. Fraser, O.B.E., E.D., M.D., CM., F.A.C.S., Medical Consultant
In the course of reviewing all hospital admissions and discharges for medical
assessment, length of stay, and medical coding, the Medical Consultation Division
processed approximately 1,400 hospital claims each working-day during 1964.
During this past year the method of medical coding has changed from the
International Classification of Diseases to the more detailed International Classification of Diseases, Adapted for Indexing Hospital Records by Diseases and Operations. The main changes in coding procedures, which involved additional work
during the past year, include:—
(1) A more detailed and precise classification of accidents, first introduced
in 19 63. This has called for special attention to be given to the classification of accidents.
(2) In January, 1964, the United States adaptation of the International Classification of diseases was introduced. The relative advantages of this adaptation are generally recognized by experts in the field, and the changes
introduced were the subject of extensive correspondence between this
Division, the Research Division, and the Dominion Bureau of Statistics.
The improved classification has made additional demands on coders as
more detailed investigation is required in some cases before the appropriate code can be determined.
Both these innnovations have improved the work of medical assessment of hospital claims and have resulted in improved statistics, which are reflected in the publications issued by the Research Division.
In July, 1963, a sub-committee of the Medical Advisory Committee was
formed to study and report on rehabilitation and activation care being carried out
in various units in Vancouver and Victoria. This study continued into 1964.
In January, 1964, the Medical Consultant visited Winnipeg to study the rehabilitation centre in operation there. He was accompanied by Dr. Brock Fahrni, Associate Professor, Faculty of Medicine, School of Rehabilitation Medicine, University
of British Columbia, and adviser to the British Columbia Hospital Insurance Service. This proved to be a very profitable experience and was of great value to the
study being carried out. The final report of this sub-committee was submitted May
20, 1964.
Mrs. Morrison, Supervisor of Medical Coders, was granted leave of absence
during the latter part of the year to complete her course to become a qualified medical-record librarian. In March she attended a course on rehabilitation medicine
at the University of British Columbia, and in April she attended an institute on
I.C.D.A. (International Classification of Diseases, Adapted) in Seattle, Wash.
 Administrative Officer
K. G. Wiper
The office of 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 application.
This work is carried out in conjunction with the Hospital Consultation and Inspection Division. 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
Collaborating with the Water Rights Service of the Department of Lands, Forests, and Water Resources and the Chief Electoral Officer of the Provincial Secretary's Department, the Administrative Officer provides guidance to committees in
unorganized territory which are establishing hospital improvement districts. Such
districts are necessary for the raising of funds by money by-laws, in areas outside
cities or municipalities, for the construction of new hospital facilities or the improvement of existing buildings. At the end of 1964 there were 36 hospital improvement
districts in operation and a number of others in the process of formation. Information regarding the procedure for establishing a hospital improvement district is
supplied by the Administrative Officer upon request.
As in previous years, considerable time was spent in 1964 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
The Adminstrative Officer is also responsible for the over-all supervision of the
Third Party Liability and EUgibility Sections.
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 received 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 Inspector 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.
 HOSPITAL INSURANCE SERVICE, 1964 K 33
Eligibility Inspectors' Section
P. A. Bacon
In order to ensure that only qualified British Columbia residents receive hospital insurance benefits, the staff of the Eligibility Section reviews all 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 were
dealt with by personal interview, telephone, and correspondence.
Eligibility Inspectors visit hospitals on a regular schedule to see that the
B.C.H.I.S. eligibility procedures are being properly carried out. These Inspectors
also assist in the training of hospital admitting-staff members. In this regard,
regional meetings are held in a number of centres for the purpose of holding panel
discussions with hospital personnel, to deal with problems connected with the admission of patients to hospitals, and their status under the Hospital Insurance Act.
This Section has provided the great majority of employers in British Columbia
with a supply of certificates on which an employee's length of employment can be
certified. The Inspectors 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.
Research Division
W. D. Burrowes, B.A., Director
The functions of the Division are:—
(1) To undertake studies of hospitalization and economic growth in different
parts of the Province, and to make recommendations to the Deputy Minister on the basis of these studies regarding the number and location of
hospital beds to be constructed:
(2) To compile and maintain a body of statistics derived from the processing
of Admission/Separation forms, and from other sources, showing the details of hospitalization in each hospital and school district:
(3) To analyse the patterns and trends of morbidity in the Province as a whole
as revealed by available statistics, and to study these data in comparison
to corresponding data for other Provinces.
During the year, bed-requirement studies were completed, or were being prepared, for the following districts: Squamish, Terrace, Trail, Kamloops, Creston,
Comox, Campbell River, Port Alberni, Penticton, North Vancouver, Burns Lake,
Port Hardy area, Kaslo, Nakusp, and New Denver.
Statistical information and forecasts of hospital bed needs were given for other
areas for which full surveys were not required.
Research into the methodology of estimating bed requirements in different
services continued during the year. The recent experience and ideas accumulated
on the planning of hospital facilities were summarized in a paper entitled " Co-ordinated Planning of Hospital Facilities."
The annual bulletin entitled " Statistics of Hospital Cases Discharged during
1963, British Columbia," was completed at the year-end. This issue was enlarged
by the inclusion of a further analysis of hospitalization by regions, race, and other
 K 34 BRITISH COLUMBIA
The annual bulletin " Statistics of Hospital Accident Cases in 1963," prepared
by this Division, was issued in October. This edition embodied a revised classification of accident cases and a detailed classification of out-patient emergency cases.
Annual statistics of patient movements in the Lower Mainland area were
brought up to date and prepared in a form suitable for circulation.
A series of relevant statistics of individual hospitals was circulated to all acute-
care hospitals. The issue of these " hospital indicators " is designed to give each
institution the benefit of comparative statistics which would not otherwise be available to them.
This Division assisted in various Departmental activities in which other divisions were involved, including a survey of private-hospital (nursing-home) patients
in Vancouver and Victoria, undertaken by Dr. Doris E. Mackay, and a nursing
activity survey at Surrey Memorial Hospital, both projects directed by the Consultation and Inspection Division of this Service.
As in previous years, card-punching and machine tabulation of data used by this
Division were undertaken by other offices—the preparation of punch cards by the
Hospital Claims Section of the Hospital Finance Division of this Service, and the
mechanical tabulation of data by the Mechanical Tabulation Unit of the Department
of Industrial Development, Trade, and Commerce.
Public Information
R. H. Thompson
The three main areas in the continuing development of public information
activities concern themselves with hospitals, the general public, and in-service duties
and responsibilities. The following is a summary of the work undertaken by this
office in 1964.
At the request of the executive of the British Columbia Hospitals' Association,
a brochure of welcome was developed for presentation to the 1,000 delegates attending the Western Canada Institute of Hospital Administrators and Trustees, held in
Vancouver in September. The Service was also asked to prepare an exhibit for the
institute, and a display was developed which illustrated the progress made by hospitals in recent years, the consultative services available to hospitals from the British
Columbia Hospital Insurance Service, and the numerous construction projects completed, under way, and approved in principle.
Assistance was given in renovating the Departmental display in the British
Columbia Building at the Pacific National Exhibition, and display material was also
provided at the request of the Department of Industrial Development, Trade, and
Commerce for use in British Columbia House, London, England.
A new poster was prepared for use in the admitting office and reception areas
of hospitals. The poster clarified the need for the patient to provide the hospital
with proof of his entitlement to receive hospital insurance coverage. Later in the
year the executive of the administrators' division of the British Columbia Hospitals'
Association asked the Service to consider developing a poster showing the costs
chargeable to the patient for the room differential between standard, private, and
semi-private accommodation, and outlining the benefits provided by the British
Columbia Hospital Insurance Service. A poster of this nature was drafted in
November for approval by the executive.
This office assisted the Hospital Consultation and Inspection Division in developing printed programme folders and evaluation questionnaires for use at the first
Private Hospitals' Institute, held in Vancouver in March.
 HOSPITAL INSURANCE SERVICE, 1964 K 35
Regular editions of the B.C.H.I.S. Bulletin were prepared during the year, and
1,500 copies of each edition were distributed to public hospitals and nursing homes.
The Bulletin is an administrative medium used to clarify policy and procedural
changes for hospital personnel. From time to time it also features condensations
of published articles on subjects of general interest to hospitals, such as safety precautions, accreditation, laundry management, and so on.
Several replacement pages, reflecting current amendments to the existing material, were printed and sent to hospitals for inclusion in their copies of the B.C.H.I.S.
manual on policy, organization, and procedure.
A start was made on a series of 35-mm. colour slides for proposed use at
regional meetings and within the Service. The first project, a photographic illustration of the processing of an Admission/Separation Record through the various
B.CH.I.S. offices, was being completed at the year-end.
Over 100 individual screenings were made by hospitals of films on loan from
the Service's 16-mm. library. A series on methods improvements was being considered for the library at the year-end.
Several press releases were prepared during the year, and feature articles were
written for national hospital journals, newspapers, and the British Columbia Government News. Other duties included the summarizing of reports, replying to
general inquiry correspondence, maintaining the newspaper and photographic files,
and editing and preparing the Sixteenth Annual Report.
General Office
C. R. Leighton
The supervision of expenditure continues to be the main function of the General Office. Administrative accounting, personnel, payroll, supplies, and assistance
in the preparation of estimates are also included in the responsibilities of this office.
Following the transfer of the admimstration of the Provincial Infirmaries to the
Health Branch, effective May 1st, this office discontinued its related responsibilities.
During the year it was decided to dispense with the premium-payment records
which terminated March 31, 1954, and permission was obtained from the Public
Documents Committee to destroy them. The annual microfilm programme was
also suspended during the year, with the intention of reducing costs. Basement
storage space was provided by this office for the hospital Admission/Separation
forms, eliminating the need for microfilming.
The office supervisor, in his capacity of Branch Safety Officer, attended the British Columbia Safety Council Convention held in Vancouver in March. For the
second consecutive year the Branch won a Safety Council award for nine months of
accident-free operation.
HOSPITALS AS DEFINED UNDER THE HOSPITAL INSURANCE ACT
Part I
Hospitals defined as such under section 2 of the Hospital Act:—
(a) Public Hospitals
Bulkley Valley District Hospital, Smithers.
Armstrong and Spallumcheen Hos
strong.
>;tal,Arm-
Burnaby General Hospital, Burnaby.
Burns Lake and District Hospital, Burns
Arrow Lakes Hospital, Nakusp.
Lake.
Bella Coola General Hospital, Bell
a Coola.
Campbell River and District General Hos
Boundary Hospital, Grand Forks.
pital, Campbell River.
 anorial Hospi
BRITISH
Villiams 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,
COLUMBIA
Royal Colun
Ende
Esperar
zaGen
al Hospital, Espen
al Hospital, Fer
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.
King's Daughters' Hospita
ilHos
icroft.
il, Nels
Lady Mint
Lady Minto Gulf Islands Hospital, Ganges.
Ladysmith and District General  Hospita'
Ladysmith.
Langley Memorial Hospital, Murrayville.
Lillooet District Hospital, Lillooet.
Lions Gate Hospital, North Vancouver.
McBride and District Hospital, McBride.
Maple Ridge Hospital, Haney.
Mater Misericordfe Hospital, Rossland.
Nanaimo Regional General Hospital,
Nicola Valley General Hospital, Merritt.
Ocean Falls General Hospital, Ocean Fa
Peace Arch District Hospital, White Roc
Penticton Hospital, Penticton.
Pouce Coupe Community Hospital, P
Prince
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.
1 Hospital, New Westmin-
Royal Inland Hospital, Kamloops.
Royal Jubilee Hospital, Victoria.
R. W. Large Memorial Hospital, Bella
St. Bartholomew's Hospital, Lytton.
St. Eugene Hospital, Cianbrook.
St. George's Hospital, Alert Bay.
St. John Hospital, Vanderhoof.
St. Joseph General Hospital, Dawson
St. Joseph's General Hospital, Comox
St. Joseph's Hospital, Victoria.
St. Martin's Hospital, Oliver.
St. Mary's Hospital, Sechelt.
St. Mary's Hospital, New Westminstei
~    7s Hospital, Vancouver.
St. 'V
alHos;
ital.Squan
d, Stew
Squami
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.
West Coast General Hospital, Port Alberni.
Windermere District Hospital, Invermere.
Wrinch Memorial Hospital, Hazelton.
(i) Outpost Hospitals
Red Cross Outpost Nursing Station, Alexis
Red Cros
Red Crc
field.
is Outpost Nursing St
I Stab'
s Outpost Nursing Station, Blue
Red Cross Outpost Nursing Station, Edge-
Red Cross Outpost Nursing Station, Hudson
Hope.
Red Cross Outpost Nursing Station, Kyuquot,
Red Cross Outpost Nursing Station, Masset
(c) Fed
UHospi
Veterans' Hospital, Victoria.
Shaughnessy Hospital, Vancouver.
Coqualeetza Indian Hospital, Sardis.
Miller Bay Indian Hospital, Prince Rupert.
Nanaimo Indian Hospital, Nanaimo.
R.C.A.F. Station Hospital, Holberg.
Private hospitals which are defined as such under
Act, and with which the Province has entered into an
7 of the Hospital
requiring the
 SERVICE, 1964 K 37
vices provided under the Hospital
Bralorne Private Hospital, 1
Cassiar Asbestos Corporal
pital, Cassiar.
Gold Quartz Hospital, Well
Part III
Rehabilitation, chronic, and convalescent hospitals, as defined under section
25 of the Hospital Act:—
G. F. Strong Rehabilitation Centre, Vancou- Queen   Alexandra  Solarium, for   Crippled
The Gorge Road Hospital, Victoria. Shaughnessy Hospital, Vancouver.
Holy Family Hospital, Vancouver. Veterans' Hospital, Victoria.
Pearson Hospital  (Poliomyelitis Pavilion);
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 1964 there were 87 public general hospitals approved to accept B.C.H.I.S. patients, the same number as in 1963. In addition,
care was provided in eight outpost hospitals, six Federal hospitals, five contract
hospitals, four public rehabilitation hospitals, one Provincial rehabilitation hospital,
and rehabilitation care units in two Federal hospitals providing general hospital care.
Data for the year 1964 have 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 I shows that a total of 278,960 B.C.H.I.S. adult and children patients
were separated (discharged) from British Columbia hospitals in 1964, an increase
of 6,363, or 2.3 per cent over the previous year. This table also shows that 95.3
per cent of the total patients separated (discharged) from British Columbia public
hospitals in 1964 were covered by hospital insurance, compared to 95.7 per cent
in 1962 and 95.4 per cent in 1963. The second part of the table indicated in 1964
that the British Columbia Hospital Insurance Service paid public hospitals in British
Columbia 2,676,290 days of care for adults and children, an increase of 44,619
days or 1.7 per cent over 1963.
As shown in Table Ha, the average length of stay of British Columbia adult
and children patients in British Columbia public hospitals during 1963 was 9.59
days, and the days of care per thousand population was 1,828, a slight decrease
from 1963. The high incidence of care, however, is a reflection of the number of
hospital beds available as a result of the continued active programme of hospital
aeet growing population needs.
 K 38                                               BRITISH COLUMBIA
Table I.—Patients Separated (Discharged or Died), Total Patient-days
and Proportion Covered by British Columbia Hospital Insurance       1
Service, British Columbia Public Hospitals Only, 1949-64 (Excluding
Federal, Private, and Out-of-Province Hospitalization) (Including
Rehabilitation Hospitals).
towh_:_3__™c
.____
s__
To_,
_____
__T
T_a,
PaUe__p_a_-
if
3I-984
I?
I!
IS
F
_g-
||
||
Pe__._gc of told, pane.- aeparated-	
wis
9_
 HOSPITAL INSURANCE SERVICE, 1964
C 39
Table I.—Patients Separated (Discharged or Died), Total Patient-days
and Proportion Covered by British Columbia Hospital Insurance
Service, British Columbia Public Hospitals Only, 1949-64 (Excluding
Federal, Private, and Out-of-Province Hospitalization) (Including
Rehabilitation Hospitals ) —Continued.
To.a.HospHalgeainPuM-
Co,ere.b.B.C.H.L,
__-L
ffisr
TO.,
cSl
as
To.
jjgES
IS
Hi
2;.5l!83"
II
|
.Mil's
2_9'M6
_'322'796
26754M
28_S268
642
Percentage of,oul. paUentdaya-
"
 K 40                                                BRITISH COLUMBIA
Table Ha.—Patients Separated, Total Days' Stay, and Average Length of
Stay According to Type and Location of Hospital for B.CH.I.S.
Patients Only, and Days of Care per Thousand of Covered Population, 1949-64 (Including Rehabilitation Hospitals).
im
_yg_?
'-SgggSS'1
&S8&
dsL
S£
^r
*__
Ardu
&
c_ffl_
n
|===
,!?
II
,?!
37!558
II
1
II
I
tSeis
aIL,^,,,--1
w-wtl
'
1=
W^^^^^^SHi
sssssfs
 HOSPITAL INSURANCE SERVICE, 1964 K 41
Table Hb.—Summary of the Number of B.CH.I.S. In-patients (Including
Rehabilitation Patients) and Short-stay Patients, 1949-64
SggS'
N_5b__
_S_?
1049
174 269
29 000
203,269
22<
§
l
300
Totals
4,065
598
1,337
073
5,402,671
Table HI.—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 19641 (Including
Rehabilitation Hospitals).
Table IV.—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 19641 (Including
Rehabilitation Hospitals).
 K 42 BRITISH COLUMBIA
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.
It should be noted that hospitalization for rehabilitative care, which has been
covered under the Provincial plan since September, 1960, is, for the first time,
represented in the charts and table.
The Canadian diagnostic list used for the table on pages 43 to 47 is a more
detailed listing than the diagnostic groups shown on the charts. Both lists are
based on the International Statistical Classification of Diseases, Injuries, and Causes
of Death, prepared by the World Health Organization.
Readers who are interested in more detailed statistics of hospitalization in this
Province may wish to refer to " Statistics of Hospital Cases Discharged during 1963 "
and & Statistics of Hospital Accident Cases in 1963."
 HOSPITAL INSURANCE SERVICE, 1964
 BRITISH COLUMBIA
!!_t
 HOSPITAL INSURANCE SERVICE, )
  HOSPITAL INSURANCE SERVICE, 1964                                K 47
Chart v.—Average Length of Stay of Cases* in Hospitals in British
Columbia, by Major Diagnostic Groups in Descending Order, 1963
(Excluding Newborns).
W//////////ll/lll/l//ll//lll//l/lll^                        . •
oi4!iH||| wiiiiiiimiiiiiimmn
n_tiMj     iiffH^
Congcmtal malformations                    WllllllllllllL'lllllllllllll"^ ^llllllllll          'MIIIIIIIIHh
1JnTsen-e°tor^n.erVOUSSyStCm               \IIIIIIIIIIIIIIHIIIIIIIIIIIIh" IIMHI                                     i
".mWir "n_ nutritional diseases        Vlllllllllllllllllllllllllll 12Alllllllllllllllllllllllllllllllln
Certa.n drseases of early .ntancy          |^^     'Iflllll "■'Willi                   'IIIIIIIIlk
' Sl'a'SdBailand       Wlllllllllllllllllll,iw /%%
Accidents, po.somngs, and                    Wlllllllllllllllll™ WIIIIIIIIIIIIIIIH^
WhBPT   *_«_!___kM!l      ■
LENGTH OTSTAY^^             _fflli!_-ffl " )W#^**^^
dSdToSl7, and i        tW///5-7 //////////////_!
'^~£fi2$f||    _//////W//////1
 K 48
BRITISH COLUMBIA
|
|3
S
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1
1
X
Q
o
Ihy?
*
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3-3
ISIsSSllss^llsSSSsfs    3.
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Is                  si_
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|||     |j
ill
W
agi
__5ob_:
SSSSSSSS
sSs    5b
nI'&-.8ni3Q<;g(.l
<£ (_,<_!
<.t.*«;_v_r
"*s:22SSS. s     as
S   5|SfiSS«'S5"'ge.SS
B              |   |
 HOSPITAL INSURANCE SERVICE, 1964
§J.SJJJ.sJ.isSlIl|§s?:.|s §J.IHI§.§r?l||.S|slifi_[l
SSSSSRHSS
S3S|3|||npl5g-iJ||pl222i |^g-KKKS|S||l^g§s§
till
ill
1_|_ '__.3"S
 BRITISH COLUMBIA
I
IF
1
S22.S
swaa 2
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sg lit
3  i
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gasaaassaasas &2 2__n 03SBS BM 2
gS§ | |S |
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I1I1P1I1-11I1 IP- ill llll PI 1
SB2 1 IS 3
Q"S
I
mwmm w m MM W I
§2- | IS |
I
3 1
j
F ^__
11
8 S_-
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lllil
fill
1    g
I'lsUs
S IN   s_
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ill
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||1
 HOSPITAL INSURANCE SERVICE, :
701
$473,922
Office expense .— 30,025
Travelling expense '— 28,984
Office furniture and equipment .  2,327
Printing and publications _.  1,168
Tabulating and rentals  2,277
Motor-vehicles and accessories —- _HS   ~~  1,440
Incidentals and contingencies  1,688
Construction—consulting fees  1,000
Technical surveys _   5,384
Less transfer, Vote 134 (b)—Salary Adjustments  27,984
Payments to hospitals— 	
Claims  $63,406,118
Vancouver General Hospital re out-patients (Hospital
Insurance Act, sec. 17 (3) (_))__ 393,732
Less collections, third-party liability 325,939
$63,473,911
Chargeable to Government of Can-
■ $33,687,396
Miscellaneous receipts _
Grants in aid of
Total
 

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