PROVINCE OF BRITISH COLUMBIA
HOSPITAL INSURANCE ACT
Twenty-first Annual Report
British Columbia
Hospital Insurance Service
JANUARY 1 TO DECEMBER 31
1969
Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia
1970
Victoria, British Columbia, January 22, 1970.
To Colonel the Honourable John R. Nicholson, P.C., O.B.E., Q.C, LL.D.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
The undersigned has the honour to present the Twenty-first Annual Report of
the British Columbia Hospital Insurance Service covering the calendar year 1969.
RALPH R. LOFFMARK,
Minister of Health Services and Hospital Insurance.
r
British Columbia Hospital Insurance Service,
Victoria, British Columbia, January 22, 1970.
The Honourable Ralph R. Lotjmark,
Minister of Health Services and Hospital Insurance,
Parliament Buildings, Victoria, British Columbia.
Sir,—I have the honour to present herewith the Report of the British Columbia
Hospital Insurance Service covering the calendar year 1969.
DONALD M. COX, F.A.C.H.A.,
Deputy Minister of Hospital Insurance.
The Honourable Ralph R. Loffmark, Minister of Health Services and Hospital Insurance, officially opened the Intensive Care Unit of Mount St. loseph's Hospital, Vancouver,
on October 1st. He was assisted by Sister Andree Dupuis, Administrator of the hospital,
and Master Douglas Friesen.
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DEPARTMENT OF HEALTH SERVICES AND
HOSPITAL INSURANCE
BRITISH COLUMBIA HOSPITAL INSURANCE SERVICE
The Honourable Ralph R. Loffmark, 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., Assistant Deputy Minister of Hospital Insurance.
J. W. Mainguy, M.H.A., Director of Hospital Consultation, Development, and Research.
D. G. Adams, M.D., CM., Medical Consultant.
N. S. Wallace, C.G.A., Manager, Hospital Finance Division.
K. G. Wiper, Administrative Officer.
P. Breel, Manager, Hospital Consultation and Inspection Division.
D. S. Thomson, B.A., Director, Research Division.
E. M. Browning, Acting Manager, Hospital Construction and Planning Division.
D. M. N. Longridge, M.A., B.Ch., F.R.C.S., Assistant Medical Consultant.
CONTENTS
Organization Chart____
General Introduction.
Page
_ 11
. 13
_ 15
British Columbia Regional Hospital Districts Act
British Columbia Regional Hospital Districts Financing Authority Act 16
The Hospital Insurance Act 16
The Hospital Act
Persons Entitled to or Excluded from the Benefits under the Hospital Insurance
Act
Entitled to Benefits
Excluded from Benefits
Hospital Benefits Available in British Columbia
In-patient Benefits
Emergency Services and Minor Surgery
Application for Hospital Insurance Benefits
16
17
17
17
17
17
18
18
The Hospital Rate Board and Methods of Payment to Hospitals 18
B.C.H.I.S. Planning Group 19
Organization and Administration 20
Assistant Deputy Minister 21
Hospital Finance Division 21
Hospital Accounting 22
Hospital Claims 23
Hospital Construction and Planning Division 25
Hospital Projects Completed during 1969 26
Hospital Projects under Construction at Year-end 27
Projects in Advanced Stages of Planning 28
Additional Projects Approved and in Various Planning Stages 28
Director of Hospital Consultation, Development, and Research 32
Hospital Consultation and Inspection Division.
Research Division
32
33
34
36
37
37
General Office 37
Public Information 38
Medical Consultation Division.
Administrative Officer
Eligibility Representatives' Section..
Third Party Liability Section
11
L 12 BRITISH COLUMBIA
Page
Approved Hospitals 39
Public Hospitals 39
Outpost Hospitals 40
Federal Hospitals 40
Private Hospitals (Providing General Hospital Services) 40
Rehabilitation, Chronic, and Convalescent Hospitals 40
Extended Care Hospitals 40
Statistical Data 41
Table 1a.—Patients Separated (Discharged or Died) and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public Hospitals Only (Excluding Federal, Private, and Out-of-
Province Hospitalization) (Including Rehabilitation Hospitals) 43
Table 1b.—Total Patient-days and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public Hospitals
Only (Excluding Federal, Private, and Out-of-Province Hospitalization) (Including Rehabilitation Hospitals) 44
Table 2a.—Patients Separated, Total Days' Stay, and Average Length of
Stay According to Type and Location of Hospital for B.C.H.I.S. Patients Only, and Days of Care per Thousand of Covered Population
(Including Rehabilitation Hospitals) 45
Table 2b.—Summary of the Number of B.C.H.I.S. In-patients (Including
Extended Hospital Care Patients) and Short-stay Patients 46
Table 3.—Patients Separated, Total Days' Stay, and Average Length of
Stay in British Columbia Public Hospitals for B.C.H.I.S. Patients
Only, Grouped According to Bed Capacity, Year 1969 (Excluding
Extended-care Hospitals) 46
Table 4.—Percentage Distribution of Patients Separated and Patient-days
for B.C.H.I.S. Patients Only, in British Columbia Public Hospitals,
Grouped According to Bed Capacity, Year 1969 (Excluding Extended-care Hospitals) 46
Charts 47
I.—Percentage Distribution of Days of Care by Major Diagnostic Groups,
1968 48
II.—Percentage Age Distribution of Male and Female Hospital Cases and
Days of Care, 1968 49
III.—Percentage Distribution of Hospital Cases by Type of Clinical Service,
1968 50
IV.—Percentage Distribution of Hospital Days by Type of Clinical Service,
1968 51
V.—Average Length of Stay of Cases in Hospitals in British Columbia by
Major Diagnostic Groups, 1968 (Excluding Newborns) 52
Hospitalization by Major Diagnostic Categories, 1968 53
Statement of Receipts and Disbursements for the Fiscal Year Ended March 31,
1969 57
Twenty-first Annual Report of the
British Columbia Hospital Insurance Service
GENERAL INTRODUCTION
Donald M. Cox, F.A.C.H.A., Deputy Minister of Hospital Insurance
The British Columbia Hospital Insurance Service completed
its twenty-first year of operation on December 31, 1969. In
the 1969/70 fiscal year an estimated $159,000,000 will be
paid by the British Columbia Hospital Insurance Service to the
hospitals of the Province toward expenses incurred by permanent residents. This is the equivalent of $72 being paid on
behalf of each man, woman, and child living in British Columbia
HMk. at the present time. Hospital Insurance Service daily payments
amounted to $435,600, as compared to $378,000 in the 1968/69 fiscal year, an
increase of 15 per cent. The expressions of concern on the part of economists
and health authorities, in both Canada and the United States, become more apparent when one considers these rapidly increasing costs at the Provincial level.
During the year, British Columbia's programme of hospital construction
continued with an accelerated pace which has been evident throughout the length
and breadth of the Province for over the past decade. Building programmes which
were under way at the year-end, many of which were due for completion early in
1970, will cost an estimated $41,500,000; and projects in the advanced stages of
planning represented an additional $25,000,000 in capital expenditure.
Communities which witnessed the completion of building programmes in
1969, including major renovations and alterations, were Abbotsford, Castlegar,
Lillooet, Powell River, Quesnel, Vancouver, and New Westminster. Centres in
which construction projects were under way as the year drew to a close included
Creston, Chilliwack, Kelowna, Nanaimo, North Vancouver, Penticton, Port Alberni, Prince Rupert, Princeton, Revelstoke, Surrey, Trail, and Vancouver.
In June, the Honourable Ralph R. Loffmark, Minister of Health Services and
Hospital Insurance, announced the completion of a publication titled " Hospitals
for Extended Care, a Programme and Design Guide," which had been prepared
by a task force consisting of three nominees of the Architects Institute of British
Columbia and three members of the British Columbia Hospital Insurance Service.
The guide consisted of a written description of all facilities to be provided in an
extended care hospital of a size suitable for construction in chosen locations, together with detailed drawings of the various hospital elements, such as ward units,
nursing stations, recreational and service areas, and so on. The electrical and
mechanical requirements were also specified in writing, and composite hospital
sketches appeared in the report. In releasing the report the Minister stated, " The
main objective of the guide is to expedite the design, production, and approval
processes for extended care hospital projects." It is of interest to note that this
publication received a great deal of publicity throughout Canada and the United
States, and was written up in the journals of both the Canadian Hospital Association
and the American Hospital Association.
13
L 14 BRITISH COLUMBIA
In the following month of July, the Minister announced that the Provincial
Government had organized a Cost-Analysis Team which would be assigned to the
study of major hospital projects. The Minister stated that the Cost-Analysis Team
would perform three major functions:—
(1) The review and analysis of the capital costs of proposed projects:
(2) The development of cost-control procedures during the detailed design
and construction phases of projects:
(3) To provide the Hospital Rate Board of the British Columbia Hospital
Insurance Service with information required in the review of estimated
operating costs of the proposed hospitals or units.
The Cost-Analysis Team will be responsible to the Treasury Board and will report
to the Minister of Health Services and Hospital Insurance, through regular monthly
progress reports to the Deputy Minister of Hospital Insurance.
In December, the Provincial Government authorized the Hospital Insurance
Service to increase the equipment allowance of 30 cents per patient-day for acute
general hospitals to 40 cents per patient-day. The increase was made retroactive
to January 1, 1969, and would provide over $300,000 in additional payments to
hospitals.
In November, 1968, the Provincial and Federal Ministers of Health directed
that intensive studies be undertaken into the Costs of Health Services in Canada.
Seven task forces were appointed, broadly representative of the medical profession,
hospitals, and other health agencies, health education, and government. The
British Columbia Hospital Insurance Service pledged its full support to the studies.
Of the seven task force chairmen, only two were Provincial personnel and significantly both were from British Columbia. Mr. J. W. Mainguy, Director, Hospital
Consultation, Development, and Research, chaired the committee on " Beds and
Facilities," and Dr. K. I. G. Benson, Assistant Provincial Health Officer, chaired
the committee " Costs of Public Health Services."
The Deputy Minister of Hospital Insurance and the Assistant Deputy Minister
served as members of the steering committee on Cost of Health Services. It is the
intention of the British Columbia Hospital Insurance Service to make full use of
the information contained in the task force reports, and in the findings of the
continuing studies.
It should be noted that although salary scales are generally higher in British
Columbia than elsewhere in Canada, the per capita cost of hospital care in British
Columbia is significantly lower than the Canadian average. That fact is stated as
an indication of the co-operation and assistance of hospital boards, hospital administrators, and the medical profession, in efforts to provide a fully satisfactory hospital
service within the limits of the ability of the people of the Province to finance.
The regional hospital districts programme fills a great need. Elsewhere in this
report will be found an outline of the extensive hospital planning and construction
programme, that would not be possible without the orderly procedure of financing
capital costs through regional hospital districts and the Regional Hospital Districts
Financing Authority.
It gives me pleasure to again express our appreciation for the good advice and
guidance so readily extended to the Hospital Insurance Service by the College of
Physicians and Surgeons, and by the British Columbia Medical Association.
Hospital laboratory and radiological services continued to improve through the
valuable assistance of the laboratory and radiological advisory councils.
As in previous years, the continuing assistance of the British Columbia Hospitals
Association was greatly appreciated.
HOSPITAL INSURANCE SERVICE, 1969
L 15
Reports submitted by the various divisions which comprise the administrative
structure of our Branch appear under " Organization and Administration," commencing on page 20.
BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS ACT
The Act provides for the division of the Province into large districts to enable
regional planning, development, and financing of hospital projects to be carried out
under a revised formula, which provides increased financial assistance from the
Provincial Government toward the capital cost of hospital projects. The Province
was divided into 29 areas, and 28 of them have been incorporated as regional hospital districts. The district not incorporated is located in an area without hospitals in
the northern part of the Province.
As is the case with school construction, each regional hospital district will, subject to the requirements of the Act, be able to pass money by-laws authorizing
debentures to be issued covering the total cost of one or more hospital projects.
When approval has been obtained from the Minister of Health Services and Hospital
Insurance, the district will be able to raise any funds immediately required by
temporary bank borrowing on a uniform basis. The Regional Hospital Districts
Financing Authority (see next page) will in due course issue and sell its own debentures in the amount required, which may cover a number of district debenture issues.
At that time the districts will then be able to sell their long-term debentures to the
Authority. Following this a district can repay any sum which has been temporarily
borrowed.
Each year the Provincial Government will pay through the Hospital Insurance
Service its share of the amortization cost in accordance with section 22 of the Act.
Each district will in turn raise, by taxation, the remainder of the annual amortization
cost required to retire its debentures which are held by the Authority.
Under the new formula the Province pays annually to each district 60 per cent
of the net cost of amortizing the district's borrowings for an approved hospital
project, after deduction of Federal Government capital grants and items which are
the district's responsibility, such as provision of working funds for hospital operation,
etc. If a 4-mill tax levy by the district is inadequate to discharge its responsibility
in regard to annual charges on old debt for hospital projects, as well as the remaining
40 per cent of the charges on the new debt resulting from a hospital project, the
Province will provide 80 per cent of the funds required in excess of the 4-mill levy.
The affairs of each regional hospital district are managed by a board comprised
of the same representatives of the municipalities and unorganized areas who comprise the board of the regional district (incorporated under the Municipal Act),
which has the same boundaries as the regional hospital district. The board of the
regional hospital district will be responsible for co-ordinating the requests for funds
from hospitals within the district, and for presenting money by-laws to the taxpayers
in respect of either single projects or an over-all programme of hospital projects
for the district.
A hospital society or corporation is not compelled to seek financing under this
new Act. In situations where the community's share of the cost can be, or has
already been, raised by other means, a Provincial Government grant under the
old 50-per-cent formula can be applied for under the procedure which was applicable up to this time.
L 16 BRITISH COLUMBIA
BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS
FINANCING AUTHORITY ACT
This Act establishes a Provincial Government authority similar to the one set up
a few years ago to assist school districts in financing their projects. The functions
of the Authority are referred to briefly in the second paragraph of the preceding
commentary regarding the Regional Hospital Districts Act.
THE HOSPITAL INSURANCE ACT
This is the Statute which authorizes British Columbia's hospital insurance plan,
and under which the British Columbia Hospital Insurance Service is established.
The main provisions of this Act and the regulations may be summarized as
follows:—
(1) Generally speaking, every permanent resident who has made his home in
British Columbia for at least three consecutive months is entitled to
benefits under the Act.
(2) Approved hospitals are paid an all-inclusive per diem rate for medically
necessary in-patient care rendered to qualified British Columbia residents
who are suffering from an acute illness or injury, and those who require
active convalescent rehabilitative and extended hospital care. The payment made to a hospital by the British Columbia Hospital Insurance
Service amounts to $1 less than the per diem rate approved for the particular hospital, and the patient is responsible for paying the remaining
dollar. The Provincial Government pays the dollar-a-day charge on
behalf of Provincial social welfare recipients.
(3) The wide range of in-patient benefits, together with the emergency outpatient, minor surgery, and day-care surgical services, provided under the
Act are described on the following pages.
(4) Qualified persons who are temporarily absent from British Columbia are
entitled to certain benefits for a period of six months if they are admitted
to an approved hospital within the first six months following their departure from the Province. These periods may be extended for an additional period of up to six months by the Lieutenant-Governor in Council.
THE HOSPITAL ACT
One of the important functions of the British Columbia Hospital Insurance
Service is the administration of the Hospital Act. The Deputy Minister of Hospital
Insurance is also the Chief Inspector of Hospitals for British Columbia under the
Statute.
The Hospital Act controls the organization and operation of hospitals, which
are classified as follows:—
(1) Public hospitals—non-profit hospitals caring primarily for acutely ill
persons.
(2) Private hospitals. This category includes (a) small public hospitals, most
of which are operated in remote areas by industrial concerns primarily
for their employees, and (b) licensed nursing homes which are not under
B.C.H.I.S. coverage.
(3) Rehabilitation, chronic, and convalescent hospitals. These are non-profit
hospitals approved under Part III of the Hospital Act, primarily for the
treatment of persons who will benefit from intensive rehabilitative and
extended hospital care.
HOSPITAL INSURANCE SERVICE, 1969
L 17
PERSONS ENTITLED TO OR EXCLUDED FROM THE BENEFITS
UNDER THE HOSPITAL INSURANCE ACT
Entitled to Benefits
A person is entitled to benefits if he qualifies as a beneficiary under the Hospital
Insurance Act. Generally speaking, a person is a beneficiary if the provision of
hospital care is a medical necessity, and if he establishes that he qualifies under one
of the following categories:—
(a) He is the head of a family, or a single person, who has made his home in
the Province and has lived continuously therein during the preceding three
consecutive months; or
(b) Having qualified under item (a), he leaves the Province temporarily and
returns after an absence of less than 12 months and resumes residence
within the Province; or
(c) He is living within the Province and is a dependent of a resident of the
Province.
During the three-month residence qualification period, a person is permitted
to be temporarily absent from British Columbia for a brief period without incurring
any postponement of the date on which he becomes a beneficiary.
With regard to item (c) above, a dependent is either the spouse of the head
of a family or a child under 21 years of age who is mainly supported by the head
of a family.
Excluded from Benefits
Some of the main classes of persons either permanently or temporarily excluded from benefits are as follows:—
(a) A person who works full or part time in British Columbia but who resides
outside the Province; or
(b) A qualified person who leaves British Columbia temporarily and fails to
return and re-establish residence within 12 months; or
(c) A qualified person who leaves British Columbia and who establishes residence elsewhere; or
(d) An inmate of a Federal penitentiary; or
(e ) A resident who receives hospital treatment provided under the Workmen's
Compensation Act, or a war veteran who receives treatment for a pensionable disability; or
(/) Persons entitled to receive hospital treatment under the Statutes of Canada or any other government; for example, members of the Armed
Forces or Royal Canadian Mounted Police, and consular officials of other
countries.
HOSPITAL BENEFITS AVAILABLE IN BRITISH COLUMBIA
In-patient Benefits
In addition to standard-ward accommodation with meals and necessary nursing
services, a beneficiary may receive any of the other services available in the hospital,
which may include:—
Laboratory and X-ray services.
Drugs, biologicals, and related preparations (with a few exceptions).
Use of operating-room and caseroom facilities.
Use of anaesthetic equipment, supplies, and routine surgical supplies.
L 18 BRITISH COLUMBIA
Use of radiotherapy and physiotherapy facilities where available.
Other approved services rendered by employees of the hospital.
(Note.—Private or semi-private rooms cost more to maintain than standard
wards, and the patient is required to pay extra for such accommodation if it is
requested by or on behalf of the patient.)
Emergency Services, Minor Surgery, and Day-care Surgical Services
The following services and treatments are also provided in British Columbia
public hospitals to beneficiaries who do not require in-patient care:—
Emergency treatment within 24 hours of being accidentally injured.
Operating-room or emergency-room services for minor surgery, including
application and removal of casts.
Day-care surgical services are available to patients who require operating-room
or other specialized treatment facilities, but who would be discharged within 24
hours.
A beneficiary is required to pay $2 for each visit to the hospital for the services,
etc., it has provided, and the remainder of the cost is paid by the British Columbia
Hospital Insurance Service. However, if the patient received treatment from a
physician while at the hospital, he is responsible for paying the doctor, as such
charges are not payable by the British Columbia Hospital Insurance Service. Non-
beneficiaries are required to pay the full charge for the hospital services and treatment received.
APPLICATION FOR HOSPITAL INSURANCE BENEFITS
At the time of admission to hospital, a patient wishing to apply for coverage
under the hospital insurance programme is required to make an Application for
Benefits. The hospital is responsible for verifying the patient's statements regarding length of residence, etc., to determine if the patient is a qualified resident as
defined in the Hospital Insurance Act and regulations. Payment is then requested
by the hospital from the British Columbia Hospital Insurance Service, which may
reject any account where either the patient's status as a qualified resident or the
medical necessity for his receiving hospital care benefits has not been satisfactorily
established. (See Eligibility Section.)
THE HOSPITAL RATE BOARD AND METHODS OF PAYMENT
TO HOSPITAL
The Hospital Rate Board, appointed by Order in Council, is composed of the
Assistant Deputy Minister of Hospital Insurance (Chairman); the Director of
Hospital Consultation, Development, and Research (Vice-Chairman); the Hospital Finance Manager; and the Hospital Consultation and Inspection Manager. The
purpose of the Board is to advise the Deputy Minister in regard to the rates of payments to hospitals for both in-patient and out-patient benefits.
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
HOSPITAL INSURANCE SERVICE, 1969 L 19
affected. However, some additional supplies will be consumed, and it is the cost
of these variable supplies which has been determined. When the number of days'
treatment provided by the hospital differs from the estimated occupancy, the budgets
are increased or decreased by the number of days' difference multiplied by the
patient-day value of the variable supplies. Individual studies and additional budget adjustments are made in those instances where large fluctuations in occupancy
involve additions or reductions in stand-by costs.
Approximately 96 per cent of all hospital accounts incurred in British Columbia
are the responsibility of the British Columbia Hospital Insurance Service. Cash
advances to hospitals are made on a semi-monthly basis, so that hospitals are not
required to wait for payment until patients' accounts are submitted and processed
by the British Columbia Hospital Insurance Service. Qualified patients are charged
$1 per day, which is deductible when calculating payments to hospitals from the
Service. Non-qualifying residents are charged the hospitals' established per diem
rates, which are all-inclusive; that is, the daily rate covers the cost of all the regular
hospital services, such as X-ray, laboratory, operating-room, etc., provided to patients, in addition to bed, board, and nursing care.
B.C.H.I.S. PLANNING GROUP
The Planning Group co-ordinates and expedites planning for hospital facilities.
Its functions are to review research reports on hospital bed needs; study submissions from hospitals and regional hospital districts for increases in beds or services;
consider other problems related to orderly planning and provision of facilities and
services to meet the needs of the Province; and to consider other matters referred
to it by the Deputy Minister. The Planning Group is responsible for making recommendations on these matters to the Deputy Minister.
The regular members are as follows: Director, Hospital Consultation, Development, and Research (Chairman); Assistant Deputy Minister (Vice-Chairman);
Medical Consultant; Manager, Hospital Construction and Planning Division; Director, Research Division; Manager, Hospital Consultation and Inspection Division.
Of the 39 meetings held during the year, 11 were with outside groups, mostly
with regional hospital districts. Meetings with regional hospital districts involved
discussion on comprehensive programmes for hospital services for a whole region.
Representatives of the Planning Group also took part in panels and meetings arranged by regional hospital districts and by agencies concerned with regional planning for hospitals.
In keeping with the emphasis on planning by regional hospital districts, the
Planning Group reviewed material prepared by the Research Division on over-all
needs by region and the Province as a whole.
The sub-committee appointed in 1968 to develop a programme and design
guide for extended care hospitals continued its work in 1969. The members of
this sub-committee joined representatives of the Architectural Institute of British
Columbia to form a task group, which completed the first edition of the guide in
April, 1969. The guide was adopted by Government as a standard for the construction of extended care units. Many requests for copies were received from
elsewhere in Canada and from other countries. A second sub-committee, examining the feasibility of new types of facility for health service in smaller communities,
was expected to bring in specific recommendations at the beginning of 1970.
The subject of day-care services was among the other planning matters reviewed. A sub-committee was appointed to develop recommendations on this type
of service.
L 20 BRITISH COLUMBIA
ORGANIZATION AND ADMINISTRATION
The British Columbia Hospital Insurance Service is a branch of the Department
of Health Services and Hospital Insurance, the other branches being Health, and
Mental Health Services. The administrative head of the Hospital Insurance Service
is Mr. Donald M. Cox, F.A.C.H.A., Deputy Minister of Hospital Insurance.
The following reports provide a brief outline of the work carried out during
1969 by the various divisions and offices which comprise the administrative structure
of this branch.
HOSPITAL INSURANCE SERVICE, 1969 L 21
ASSISTANT DEPUTY MINISTER
W. J. Lyle, F.C.I.S.
The Assistant Deputy Minister is responsible for the operation of the Hospital Finance Division and the Hospital Construction and Planning Division, and for the administration of
the Service in the absence of the Deputy Minister. He is
Chairman of the Hospital Rate Board (see page 18), Vice-
Chairman of the B.C.H.I.S. Planning Group (see page 19), and
a member of the following committees: Advisory Committee
on Hospital Insurance and Diagnostic Services (a committee
appointed by the Federal Government to advise on the administration of the
Hospital Insurance and Diagnostic Services Act), the Sub-committee on Finance,
the Radiological Advisory Council, and the British Columbia Hospitals' Association
Liaison Committee.
During 1969 the Assistant Deputy Minister was a member of the steering
committee on Costs of Health Services, established by the Conference of Ministers
of Health of Canada in November, 1968, to inquire into ways of restraining the
rate of increase in health service expenditures.
A summary of the activities of the two Divisions for which the Assistant
Deputy Minister is responsible follows.
Hospital Finance Division
N. S. Wallace, C.G.A., Manager
^^ Hospital accounting, the payment of hospital claims, and
financing of hospital capital projects are the three main functions
of the Hospital Finance Division.
f*ff. At the 3 967 Session of the Legislature, two Acts were
■M; passed which changed the method of financing hospital capital
projects—the Regional Hospital Districts Act and the British
Jfe» Columbia Regional Hospital Districts Financing Authority Act.
^■j.i' mSm The Finance Division is responsible for reviewing the annual
budgets prepared by each regional hospital district as required by the legislation,
and works closely with the Hospital Financing Authority and the regional hospital
districts in the financing of hospital capital projects and repayment of debentures.
During 1969 the Finance Division assisted the regional hospital districts in debenture sales to the British Columbia Regional Hospital Districts Financing Authority
amounting to $16,920,000 and provided capital grants of approximately $1,311,000
toward the repayment of principal and interest on capital borrowings of the regional
hospital districts.
The Finance Division is also responsible for the approval of grants to assist
hospitals in the purchase of equipment. In 1969, after a review of approximately
5,200 applications received from hospitals, grants estimated at $1,909,000 were
approved on movable and fixed technical equipment costing $5,800,000.
As a means of assisting hospital employees to maintain high working standards,
the Hospital Insurance Service provided over $130,000 during the year to enable
hospital employees to attend or participate in short-term training programmes. This
was additional to the long-term educational training courses sponsored for certain
hospital employees through Federal assistance.
J
L 22 BRITISH COLUMBIA
Close liaison was continued with the Commissioner of Municipal Superannuation in respect to the application of the Act to hospital personnel, and the postponement of retirement for certain employees who reach maximum retirement age.
The Division Manager continued to perform duties as a member and Secretary
of the Hospital Rate Board and as a member of the Sub-committee on Hospital
Finance and Accounting (a sub-committee appointed by the Federal Government
to advise on the administration of the Hospital Insurance and Diagnostic Services
Act).
Experience during the first few years' operation of the British Columbia Hospital Insurance Service indicated that operating costs required serious consideration
when planning new hospitals and additions to existing hospitals. In order to ensure
that plans for new hospitals or hospital additions are prepared with economical
and efficient operation in mind, a system of pre-construction operating budgets
is used.
The procedure requires a hospital to prepare an estimate of staff and other
costs, based upon a reasonable occupancy for the new area. These estimates are
submitted to the British Columbia Hospital Insurance Service and are reviewed by
the Hospital Rate Board in the same manner as normal operating estimates. It is
essential that the estimated operating costs of the new hospital, or new addition,
compare favourably with other hospitals actually in operation. Where the hospital's
pre-construction operating estimates do not indicate a reasonable operating cost,
it is necessary for the hospital board to revise its construction plans to ensure
efficient and economical operation. Once a satisfactory pre-construction operating
estimate has been agreed upon by the hospital officials and the British Columbia
Hospital Insurance Service, the hospital board is required to provide written guarantees relative to the projected operating cost. It is considered that this method of
approaching the operating picture for proposed hospital facilities ensures more
satisfactory planning, efficient use of hospital personnel, and an economical
operation.
Hospital Accounting
H. G. Benjamin, C.G.A., Supervisor
The work of the Hospital Accounting Section falls into three main categories: (a) the detailed inspection, in the field, of the financial records of the
hospital for purposes of verification of annual and other financial statements;
(b) the assembly of relevant information and preparation of tabulations and other
data for the use of the Hospital Rate Board in its review of the hospital's annual
operating and pre-construction estimates; and (c) the assembly of information
and preparation of data for the Deputy Minister in the review of the annual
budgets of regional hospital districts. Work in category (c) is a result of the
passage of the Regional Hospital Districts Act at the 1967 sitting of the Legislature.
In carrying out the inspection duties in 1969, visits were made at least once to
each of 102 public general, rehabilitation, and extended care hospitals. The gross
expenditure approved by the Hospital Rate Board for public general, rehabilitation,
and extended-care hospitals for the year 1969 amounted to $151,000,000.
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.
HOSPITAL INSURANCE SERVICE, 1969
L 23
(c) Checking and amending annual financial and statistical reports prepared
by hospitals for the Dominion Bureau of Statistics and the Department of
National Health and Welfare.
(d) The provision, on request, of accounting assistance and instruction to
smaller public hospitals in the Province.
(e) The carrying-out of accounting reviews and cost studies of nursing homes,
upon the request of the Social Welfare Department, for welfare payment
purposes.
(/) The auditing of accounts of hospital construction projects, to determine
the amount of construction grants payable by the Province.
The Annual Report on Hospital Statistics, issued by the Department of Health
Services and Hospital Insurance and covering the administration of the Hospital Act
for the preceding year, is prepared by this office.
During 1969, construction projects involving expenditure of $14,450,000 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. In
addition, cost reports involving expenditures of $33,200 for minor construction
projects were prepared for regional hospital districts.
Annual accounting inspections of hospitals were delayed because of the difficulty in recruiting experienced hospital accounting personnel.
Hospital Claims Section
W. J. Wade, Supervisor
The staff of Hospital Claims is responsible for processing the Admission-
Separation Records (accounts), which hospitals submit for each patient, and
approving for payment all acceptable claims. Assistance is provided to hospitals
by the Section in the proper method of submitting the individual accounts. This
is accomplished by correspondence, telephone, and personal visits. During the
year the supervisor visited hospitals in the Vancouver Island and Lower Mainland
areas.
During July, the Hospital Claims Section moved to a new location in the same
building, which provided greater space and relieved the overcrowding. This move
will allow the increased volume of Hospital Claims accounting requirements to be
processed more efficiently.
The filing, accounting, and review of the quarterly billing for extended care
hospital patients continued to increase in volume as new units were added to hospitals or new hospitals added to the programme.
Research and adjustments to accounts, due primarily to changes of responsibility, showed an increase in volume.
Accounts processed were in excess of 1,700 per working-day for in-patients,
and over 850 emergency-service or minor-surgery account forms were handled per
working-day. Discussions with the Data Processing Centre were continued during
the year regarding the efficient use of the I.B.M. electronic data-processing equipment. These included discussions on special surveys and statistical procedures.
A brief outline of the work and duties performed by the various offices of the
Hospital Claims Section follows.
The staff of Admission Control reviews each application for benefits made by
patients who claim to be qualified for benefits under the Hospital Insurance Act.
Details of residence are checked with the verifying documents; during the year over
8,000 had to be returned to hospitals because they were incomplete or unacceptable.
L 24 BRITISH COLUMBIA
Advice and assistance were given to hospital admitting staffs on the proper method
of obtaining and recording the patient's residence information and employment
history.
In order to further assist in the co-operation between the British Columbia
Hospital Insurance Service and hospitals, the supervisor of Admission Control visited hospitals for discussions of the procedures being used for verification of the
residence of patients.
Areas visited included Nanaimo, Prince George, Dawson Creek, Cranbrook,
and Kamloops.
The Accounts Payment staff pre-audits the charges made to the British Columbia Hospital Insurance Service, and ensures that all information shown on each
claim is completed so that it can be coded for statistical purposes, and that it is
charged to the correct agency, such as to the British Columbia Hospital Insurance
Service, Workmen's Compensation Board, the Department of Veterans Affairs, or
other Provinces and Territories. During the year over 700 queries per month on
such accounting matters were addressed to British Columbia hospitals.
Preliminary figures for 1969 show that more than 415,000 accounts (excluding out-of-Province) were processed. For comparison the figures for 1968 were
400,000 processed.
The Day-care Surgical Services and Day-care Psychiatric Accounts area increased its monthly volume during the year from 1,135 to over 1,700 accounts at
the year-end.
The Voucher and Key-punch staff 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 used to
tabulate remittance listings of payments due to hospitals and for morbidity statistics
for the Research Division. New procedures included the new out-of-Province account cards and the day-care surgical services account cards.
The Out-of-Province personnel process all claims for hospital accounts incurred by British Columbia residents in hospitals outside the Province. This requires establishing eligibility and the payment of claims. During 1969 over 5,000
accounts, amounting to an estimated $1,500,000, were paid on behalf of qualified
residents who were hospitalized in the other Provinces and Territories of Canada
and the continental United States, including Alaska and Hawaii; Argentina, Austria, Australia, Bahamas, Belgium, British Honduras, Denmark, Ecuador, England,
Finland, France, Holland, Hong Kong, Hungary, Iceland, Ireland, Israel, Italy,
Jamaica, Japan, Mexico, Morocco, New Zealand, Norway, Peru, Philippines, Portugal, Scotland, South Africa, Sweden, Switzerland, Trinidad, West Germany, and
Yugoslavia.
Correspondence to accomplish the procedures amounted to over 17,800 letters
for the year. This office also compiles up-to-date hospital rate schedules for every
approved hospital in Canada. All accounts were coded for statistical purposes and
an I.B.M. card punched for each account.
The Filing and Mail Unit sorted and filed over 6,500 documents and letters
daily, an increase of 1,000 over last year. The filing system was expanded and new
procedures instituted, in order to accommodate the increase.
HOSPITAL INSURANCE SERVICE, 1969
L 25
Hospital Construction and Planning Division
E. M. Browning, Acting Manager
The primary responsibilities of this Division may be sum-
II marized as follows:—
(1) Working with hospital boards of management and
hospital construction and planning committees in the
development of programmes for the construction of
new hospital facilities, and additions to and renovations of, existing hospitals.
(2) providing consultative services to hospitals which are
planning projects, and recommending such programmes for approval.
(3) Processing and recommending for approval applications for Provincial
grant assistance, either by direct grants or through Regional Hospital Districts, for 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.
During the year a great deal of time was spent in reviewing plans of proposed
building projects, both at the sketch-plan stage and the working-drawing stage.
Drawings and the architectural programme which evolved from the hospital's functional programme were reviewed with the various professions represented in the
Consultation, Finance, or Medical Consultation Divisions, or in allied organizations
such as the Radiology Advisory Council and the Laboratory Advisory Council.
Reviews are made with several objectives, but basically the intent is to ensure
that, in terms of the construction funds available, the greatest benefit will be derived
and that the funds are distributed in an equitable fashion. Therefore, comments
included alternate solutions which might produce a better plan for the same amount
of money, on items which may have an unwarranted influence on operating costs,
and on items which were felt to be inconsistent with the philosophy of the lower
initial cost, consistent with good service and acceptable standards.
During the year, liaison was maintained with the mechanical engineering profession in recognition of the need to design high-quality mechanical systems that
would make a maximum contribution toward an efficient and economical hospital
operation. Some of the elements included in designs for mechanical systems for
new hospital buildings, that reflect this approach, included air recirculation and
zoned heating and ventilating controls.
Consultative advice is given to hospitals, as well as other departments of the
Hospital Insurance Service, in the fields of plant operation and equipment selection.
Liaison was maintained with the Hospitals Committee of the Architectural
Institute of British Columbia. The function of this committee is to review and
endeavour to resolve problems arising out of hospital construction projects which
affect members of the Architectural Institute. An architect on the Division's staff
is a member of this committee.
Hospital boards were provided with a complete consultative planning service
through this Division, and through the co-operation of Health Branch personnel,
L 26 BRITISH COLUMBIA
members of the medical and nursing professions, and other divisions of the British
Columbia Hospital Insurance Service. The Provincial Health Branch provided
assistance through the Division of Public Health Engineering, the Technical Supervisor of Clinical Laboratory Services, and the Technical Superivsor of Radiology.
Proposed layouts for physical medicine departments were reviewed by the physio
and occupational therapists on the staff of the School of Rehabilitation Medicine,
Faculty of Medicine, University of British Columbia. Through the co-operation
of the Provincial Department of Labour, the Office of the Inspector of Factories
provided a consultative service to the British Columbia Hospital Insurance Service
on proposals for elevators and dumb-waiter installations in hospitals.
Members of the staff of this Division participated in the development of the
publication " Hospitals for Extended Care, a Programme and Design Guide " (please
refer to page 13).
Continuing benefit was derived from the co-operation of the Department of
Public Works in the assignment of architects to this Division. In 1969 an additional architect, Mr. R. D. Goldsworthy, joined the staff, making a total of three
architects and a research assistant. Mr. W. M. MacLean, an engineer, also joined
the staff of this Division. At the year-end the position of Manager had been advertised and likely candidates were being considered.
During 1969, the architects and engineers made a number of inspectional, advisory, and educational visits to hospitals throughout the Province, and Mr. J. M.
Phillips visited the construction and planning offices in the Washington State Department of Health, Olympia. Mr. Phillips was also appointed as a member of the
Hospital Cost Analysis Group, the co-ordinator of which is Mr. J. E. Breeze, Head
of the Division of Engineering in the British Columbia Research Council. A senior
architect and a quantity surveyor from the Department of Public Works comprise
the remainder of the group.
A three-day seminar for hospital engineers was held at the Prince George Regional Hospital in November. This was conducted through the co-operation of
the British Columbia Hospitals Association and staff of this Division. Staff members devised a simplified system of plant maintenance, which was introduced at this
seminar and has since been incorporated in some hospitals in the Province. The
simplicity of the system was proving to be beneficial in the care of plant and
equipment.
(a) Hospital Projects Completed during 1969
Matsqui-Sumas-Abbotsford General Hospital, Abbotsford.—An addition and
renovation project resulted in a gain of 32 acute beds, making a total capacity of
109 beds. As the renovation of existing areas continued into the month of December, no official opening was held, but the new patient accommodation had been in
use for some months.
Castlegar and District Hospital, Castlegar.—On November 8, 1969, the Honourable D. L. Brothers officially opened the expanded Castlegar hospital. This
project involved the construction of a second story, containing 60 acute beds, over
the existing hospital, which was then altered to expand the diagnostic, treatment,
and service areas.
Lillooet District Hospital, Lillooet.—At the beginning of the year this hospital's capacity was increased by 12 pediatric beds, housed in four temporary prefabricated units.
HOSPITAL INSURANCE SERVICE, 1969
L 27
Royal Columbian Hospital, New Westminster.—Renovations were completed
in the emergency department, to provide a 4-bed Trauma unit.
Powell River General Hospital, Powell River.—Four additional extended-care
beds were completed and brought into service in May, bringing the capacity of the
extended-care unit to 30 beds.
G. R. Baker Memorial Hospital, Quesnel. — Twenty-two previously semifinished beds were completed during the year, bringing the total acute capacity to
100 beds.
Canadian Red Cross Society, British Columbia-Yukon Division, Vancouver.—
The Provincial Government, through the Hospital Insurance Service, provided funds
for the blood-transfusion section in the new Red Cross building completed in 1969.
Children's Hospital, Vancouver.—A new laboratory, providing a metabolic
investigation unit, was completed during the summer.
Vancouver General Hospital.—Two separate projects were completed at this
hospital—(1) a Home Dialysis Training Unit was opened on June 27, 1969. This
home-like building, containing two beds, trains four patients at a time on a rotating
basis, in the method of haemodialysis which will be carried on in their own homes.
(2) A 50-bed temporary building for emergency patients came into operation on
November 4, 1969.
Health Sciences Centre, University of British Columbia, Vancouver.—Patients
admitted to 60-bed psychiatric unit.
(b) Projects under Construction at Year-End
Chilliwack General Hospital, Chilliwack.—Phase I of expansion programme,
moving old nurses' residence and altering building for alternate use.
Creston Valley Hospital, Creston.—Construction of an addition and renovations to existing areas, to provide a total of 44 acute beds, plus 8 unfinished.
Kelowna General Hospital, Kelowna.—Two separate projects were under way
—the first, which was nearly finished at the year-end, is a new 175-bed acute block;
the second a 71-bed extended-care unit.
Nicola Valley General Hospital, Merritt.—This hospital is completing a previously unfinished 4-bed ward, increasing the hospital's capacity to 41 acute beds.
Nanaimo Regional General Hospital, Nanaimo.—An addition is being constructed to provide 85 extended-care, 24 psychiatric, and 25 activation/rehabilitation beds, as well as a large physio- and occupational-therapy department, and enlarged dietary and locker facilities, etc.
Lions Gate Hospital, North Vancouver.—Construction of a 169-bed extended-
care unit.
Penticton Hospital, Penticton.—An expansion programme, consisting of additions which will eventually provide the hospital with 159 acute beds and an unfinished top floor in " shell " form; a 63-bed extended-care unit; expansion of services;
and renovations to the existing hospital building.
West Coast General Hospital, Port Alberni. — Completion of top floor and
additional construction, which will increase the hospital's capacity to 139 acute
beds and 30 extended hospital-care beds. The project included renovations of
existing areas and construction of additions to provide enlarged service departments.
L 28 BRITISH COLUMBIA
Prince Rupert General Hospital, Prince Rupert.—Construction of a new building to provide 128 acute beds and accommodation for 18 extended-care beds.
Princeton General Hospital, Princeton.—New 25-bed acute hospital.
Queen Victoria Hospital, Revelstoke.—Construction of new 50-bed hospital
with an unfinished area for 10 additional beds.
Surrey Memorial Hospital, Surrey.—Two separate projects were under way—
construction of new additions to provide a further 186 finished beds and 72 unfinished, plus renovation of the existing hospital, and the construction of a 78-bed
extended-care unit.
Trail Regional Hospital, Trail.—Two separate projects were under way—an
addition to accommodate a new regional laboratory and 24 psychiatric beds was
nearly completed, a 50-bed extended-care unit was under construction.
Royal Jubilee Hospital, Victoria.—Major laboratory addition and renovation.
(c) Projects in Advanced Stages of Planning
Lady Minto Hospital, Ashcroft.—Replacement.
Burnaby General Hospital, Burnaby.—Extended-care unit.
Burns Lake and District Hospital, Burns Lake.—Additions and renovations.
Chetwynd and District Hospital, Chetwynd.—New facility of 30 beds.
Chilliwack General Hospital, Chilliwack.—Additions and renovations.
Fort St. James Hospital, Fort St. James.—New facility of 25 beds.
Fraser Canyon Hospital, Hope.—Expansion and renovations.
Windermere District Hospital, Invermere.—Expansion.
Royal Inland Hospital, Kamloops.—Renovations to provide approximately 40
beds in existing areas of hospital.
Victorian Hospital, Kaslo.—Replacement.
Kelowna General Hospital, Kelowna.—Renovation of existing hospital.
Royal Columbian Hospital, New Westminster.—Temporary accommodation in
prefabricated units; renovations.
Ocean Falls General Hospital, Ocean Falls.—Replacement.
Richmond General Hospital, Richmond.—Extended-care unit.
Shuswap Lake General Hospital, Salmon Arm.—Expansion.
St. Mary's Hospital, Sechelt.—Expansion programme and extended-care unit.
Vancouver General Hospital.—Extended-care unit and Willow Pavilion renovations.
Health Sciences Centre, University of British Columbia, Vancouver. — New
hospital facility (Stage III).
G. F. Strong Rehabilitation Centre, Vancouver.—Expansion.
St. John Hospital, Vanderhoof.—Replacement.
(d) Additional Projects Approved and in Various Planning Stages in 1969
Lady Minto Hospital, Ashcroft.—Replacement.
R. W. Large Memorial Hospital, Bella Bella.—Replacement.
Burnaby General Hospital, Burnaby.—Expansion, including 427 additional
acute beds.
HOSPITAL INSURANCE SERVICE, 1969
L 29
Campbell River and District General Hospital, Campbell River.—Expansion
of acute hospital.
Cranbrook and District Hospital, Cranbrook. — Expansion of extended-care
unit, 8 additional beds.
St. Joseph General Hospital, Dawson Creek.—Expansion.
Cowichan District Hospital, Duncan.—Extended-care unit.
Fernie Memorial Hospital, Fernie.—New hospital to serve Fernie and Michel
areas.
Lady Minto Gulf Islands Hospital, Ganges.—Extended-care unit.
Golden and District General Hospital, Golden. — Expansion and 4-bed extended-care unit.
Boundary Hospital, Grand Forks.—Completion of 5 acute beds and provision
of 14 extended-care beds.
Maple Ridge Hospital, Haney.—New 75-bed extended-care unit.
Wrinch Memorial Hospital, Hazelton.—Replacement of acute hospital, plus 7
extended-care beds.
Royal Inland Hospital, Kamloops.—Expansion, including extended-care unit,
psychiatric, and activation/rehabilitation beds.
Lillooet District Hospital, Lillooet.—Expansion of acute beds, plus approval
to plan 6 extended-care beds.
Mackenzie.—New facility.
Langley Memorial Hospital, Murrayville.—Expansion.
Arrow Lakes Hospital, Nakusp. — New hospital to serve Nakusp and New
Denver.
Royal Columbian Hospital, New Westminster.—Expansion.
Lions Gate Hospital, North Vancouver.—Expansion of services.
St. Martin's Hospital, Oliver.—Replacement.
Prince George Regional Hospital, Prince George.—Expansion and extended-
care unit.
Saanich Peninsula.—New 75-bed acute hospital (replacing Rest Haven Hospital, Sidney) and 75 extended-care beds.
Bulkley Valley District Hospital, Smithers.—Expansion.
Squamish General Hospital, Squamish.—Renovations and improvements.
Children's Hospital, Vancouver.—Replacement.
Holy Family Hospital, Vancouver.—Expansion and extended-care unit.
St. Paul's Hospital, Vancouver.—Expansion.
Mount St. Joseph Hospital, Vancouver.—Expansion and extended-care unit.
St. Vincent's Hospital, Vancouver.-—Extended-care unit.
Gorge Road Hospital, Victoria.—Extended-care unit.
Mount St. Mary Hospital (St. Joseph's), Victoria.—Extended-care unit.
Priory Hospital, Victoria.—Extended-care unit.
Royal Jubilee Hospital, Victoria.—Extended-care unit; renovations.
St. Joseph's Hospital, Victoria.—Expansion, ambulatory-care unit; renovations.
Cariboo Memorial Hospital, Williams Lake.—Expansion.
Major Hospital Projects, 1969
Completed.—Abbotsford, Castlegar, Lillooet, New Westminster (Royal Columbian), Powell River, Quesnel, Vancouver (Children's Hospital, Vancouver
General).
Under Construction.-—Chilliwack, Creston, Kelowna, Merritt, Nanaimo, North
Vancouver, Penticton, Port Alberni, Prince Rupert, Princeton, Revelstoke, Surrey,
Trail, Victoria (Royal Jubilee).
For details see pages 26 to 27.
Castlegar and District Hospital—
Major expansion programme completed.
New Ja?6y Memo»al Hospital-
NeWaddlU0nsand novations under way.
New ,H^reSt0n Valley Hospital-
New addrtions and renovations under way.
/S!?"Gfnfral Hospital-
New 25-bed acute hospital under
way.
L 32
BRITISH COLUMBIA
DIRECTOR OF HOSPITAL CONSULTATION, DEVELOPMENT,
AND RESEARCH
J. W. Mainguy, M.H.A.
The Director is responsible for the operation of both the
Hospital Consultation and Inspection Division and the Research
Division, and is Assistant Chief Inspector of Hospitals under the
Hospital Act, the Chief Inspector being the Deputy Minister.
The Director is responsible for the administration of the Service
in the absence of the Deputy and Assistant Deputy Minister.
He is Chairman of the B.C.H.I.S. Planning Group and Vice-
Chairman of the Hospital Rate Board. The work undertaken
during the year in connection with these activities is outlined on pages 19 and 18
respectively. He represents the Service on a number of committees of Government
and community agencies, including the Co-ordinating Committee on Paramedical
Training of the British Columbia Institute of Technology, Burnaby; the Liaison
Committee between the Service and the British Columbia Hospitals' Association;
and the Sub-committee on Quality of Care and Research, Ottawa.
In February, the Director was appointed as Chairman of the national Task
Force on Beds and Facilities. This group was one of seven established by the
Conference of Ministers of Health of Canada to inquire into ways of restraining
the rate of increase in health service expenditures without impairing the quality of
care. Each task force examined a specific aspect of the cost of health care. Reports
of all task forces were completed by mid-year.
Reports of the activities undertaken by the two Divisions responsible to the
Director follow.
Hospital Consultation and Inspection Division
P. Breel, Manager
This Division provides public and private hospitals with
consultative services in all matters of hospital operation and
administration. It is responsible for an inspectional programme
to ensure that basic standards are met, and for the licensing of
private hospitals.
Its staff is composed of administrative, nursing, dietary, and
management engineering consultants.
The Division co-operates with all other divisions of the
Service in achieving aims of mutual interest and responsibility. It is responsible
for the analysis, and subsequent recommendations, for approved staffing patterns
resulting from hospital estimates. The Manager is a member of both the Hospital
Rate Board and the Planning Group. Staff members also participate in the hospital-
planning functions of the British Columbia Hospital Insurance Service, including
the review of the operational implications of construction projects, and the setting
of standards. Sketch plans are analysed and assessed, in conjunction with the
Hospital Construction and Planning Division. The Division represents the Service
on a large number of councils, committees, and working parties associated with
hospitals and the health field, and works with Federal, Provincial, and municipal
representatives on related matters.
During 1969, 170 staff visits were made to acute, rehabilitation, chronic,
convalescent, and extended-care hospitals. In addition, 203 visits by nursing and
other staff consultants were made to private hospitals giving nursing-home care.
HOSPITAL INSURANCE SERVICE, 1969
L 33
During the past year, 18 studies were completed by the management engineering
unit, 11 of which were requested by individual hospitals or groups of hospitals.
Study reports, released with the approval of the hospitals concerned, were
circulated throughout British Columbia, other parts of Canada, the United States,
and the United Kingdom.
Personnel of the Division attended a variety of educational sessions during
the year, as a necessary means of keeping abreast of changing concepts and techniques in the hospital field.
In February, 1969, Mr. J. Bainbridge resigned as Manager of the Division
to become Administrator of the Vernon Jubilee Hospital. Mr. Breel was appointed
as Manager, and Mr. E. C. Luscombe became Senior Administrative Consultant.
Research Division
D. S. Thomson, B.A., Director
The Research Division is responsible for compiling and
maintaining statistical data relating to hospitalization and morbidity in British Columbia. The Admission/Separation Records,
submitted by the hospitals for each in-patient, serve as the major
source of reference in deriving statistical information. The data
used are key-punched by the Hospital Claims Section of this
Service, and then transferred to magnetic tape by the Data Processing Division of the Department of Industrial Development,
Trade, and Commerce, which produces the required tabulations.
Each year the Division carries out bed-requirement studies and prepares
statistical data at the request of hospitals and independent consultants on hospital
utilization. During 1969, over 70 requests were answered involving patient-flow
data and population-growth projections, relating to hospital catchment areas, school
districts, and regional hospital districts.
The formation of regional hospital districts brought about a greater need for
determining hospital requirements on a regional scale, particularly concerning
services that can be shared by one or more hospitals within a region. In 1968,
a Province-wide study was undertaken to determine both school district and
regional hospital district bed needs, and to account for all patient movement within
and without each of the 27 regions. This study was completed during the past year
and serves as a guide to future planning.
The Division is responsible for the publication of several annual bulletins
which have, over the years, been useful to various research groups and agencies
throughout the Province and Canada. " Statistics of Hospital Cases Discharged
in 1968," completed during the year, included 10 standard morbidity tables as
suggested by the Federal Advisory Committee on Hospital Insurance and Diagnostic Services, along with an analysis of the Province's hospitalization experience
by race, age, regional hospital district, major diagnostic group, and type of service.
" Statistics of Hospitalized Accident Cases " provided a broad analytical coverage
of hospitalized accidents by circumstance, type of accident, and by nature of
injury. In addition, a number of statistical tables, entitled " Hospital Indicators,"
were circulated to all hospitals. These indicators allow the individual hospital to
focus attention on its own performance, as well as making a comparison with
hospitals of a similar size-group. A further series of reports produced by this
Division involved an analysis of patient-flow patterns within five of the larger
regional hospital districts.
L 34 BRITISH COLUMBIA
As the field of hospital development takes on an increasing and more complex
role in the provision of health care, a continuing study is being made of the assessment of hospital needs. In 1969, British Columbia co-operated in a comparative
study, involving hospital utilization experience, with hospitals in Liverpool, New
England, and Uppsala, Sweden. Also during the year the Division provided the
statistical analysis on a survey to identify factors affecting patient length of stay.
An increasing number of special requests by community agencies, private
organizations, and by Government are processed each year.
MEDICAL CONSULTATION DIVISION
D. G. Adams, M.D., Medical Consultant
Dr. Charles F. Ballam, who served as Medical Consultant
with the Hospital Insurance Service since January, 1966, resigned his position in August to become Medical and Educational
Director for the Royal Jubilee Hospital, Victoria. Dr. Douglas
G. Adams was appointed Medical Consultant on September 1,
1969.
The Admission/Separation Record, which is completed for
each patient admitted to a hospital either in British Columbia or
while out of the Province, is assessed with regard to its medical aspects by this
Division. This review includes coding, which is done in accordance with the
" International Classification of Diseases, Adapted for Indexing Hospital Records
by Diseases and Operations," and is a function which requires the professional
knowledge and training of medical coders. The competence and accuracy applied
to this work is reflected in the statistical end-product, and to ensure a continuing
high standard all coders on the staff of this Division are graduate nurses. The
statistical data are basic to planning decisions, for expanding or developing hospital
facilities generally, and special departments in certain hospitals, in particular. In
addition, this coded information is utilized by the Research Division of the British
Columbia Hospital Insurance Service and the Dominion Bureau of Statistics for
the publication of hospital morbidity and mortality data. Other functions of the
review include bed usage, identifying special area requirements by reason of
geographical or industrial development, and assessing complicated individual cases,
when required.
In co-operation with such bodies as the Faculty of Medicine of the University
of British Columbia, the College of Physicians and Surgeons of British Columbia,
and departments of Government, special medical research projects were a part of
the work of this Division during the year. These studies were greatly benefited by
legislation which made the data of such studies privileged information, and not
subject to litigation.
The assessment and review of individual patients' applications for extended-
care coverage continued to provide an increasing workload. A quarterly review of
all extended-care hospitals was undertaken, with two objectives—(1) a medical
audit, to ensure patients continue to be medically qualified for this benefit, and
(2) for the purpose of reviewing and assisting in the treatment programme provided
by the hospital—in order that the care which the patient receives is commensurate
with current thinking in the management of chronically disabled individuals. In the
development of this programme the Medical Consultation Division had the assistance
of qualified consultants in physical medicine, whose specialized knowledge was of
great value. Several new extended-care units were opened during the year, increasing the application review load, and at the same time placing increased demands
HOSPITAL INSURANCE SERVICE, 1969
L 35
for professional advice on the implementation of treatment programmes in these
new units.
Dr. D. M. N. Longridge was appointed Assistant Medical Consultant during
the year, and has major administrative supervisory responsibility for the Coding
Division, and the survey and review projects previously mentioned. In addition,
administration of the medical aspects of the extended-care programme is under his
supervision. Management of the day-to-day problems which arise in the administration of these matters enables Dr. Longridge to participate with the Medical
Consultant in the preparation of policy recommendations to the Deputy Minister,
dealing with hospital conditions and needs.
Day-care surgical services, approved as a hospital insurance benefit in 1968,
have improved the utilization of the Province's health facilities, and the Medical
Consultant continued to advise the Service in its planning for an expanded role
in ambulatory-patient care. As was the case with the in-patient admission records,
all day-care surgical services records were assessed and coded according to the
International Classification of Diseases, so that these data may be tabulated in
preparation for statistical reviews.
The Medical Consultant, while maintaining responsibility for the foregoing,
also ensured continuing and active liaison, through visits to hospitals, special disease
groups, societies, and health agencies. Liaison with the British Columbia Medical
Association, and active participation on its Hospitals Committee and the Advisory
Sub-committee on Chronic Renal Failure, continued during the year. New committees to consider radioisotope facilities and intensive coronary-care services were
set up by the British Columbia Medical Association at this Service's request, and
both Medical Consultants participated directly with these advisory bodies. As a
result of the reports received from the committees studying radioisotope and intensive cardiac-care facilities, continuing advisory sub-committees were developed,
and the Medical Consultants were asked to serve on both continuing committees.
During the year a new committee was formed to study future developments in
cancer therapy for the Province, and the Medical Consultant was named as a
member of the committee.
The encouragement of hospitals to achieve accreditation standards imposes
certain pressures to conform to the requirements of accreditation, and when these
pressures produce problems for the medical staff of the hospital, the Medical Consultant is able, with the assistance of the Hospital Consultation and Inspection
Division, to render assistance.
The Medical Consultant also advises the Service on the proposed addition or
extension of medical services in hospitals. New treatment services require additional equipment, and in current times not only must the traditional hospital departments be supplied with modified equipment, but new technology in the bio-medical
sciences is introducing new diagnostic and treatment services which require equipment unheard of five to ten years ago. There is a constant and rising demand to
keep abreast of the change in medicine, and to call upon ancillary consultative
advice from specially talented individuals, as well as organized technical groups
from the profession. During the year the resources of other Government departments, namely, the Health Branch and Mental Health Services, were utilized where
problems were related to these special fields, and particularly where the treatment
services being made available in acute general hospitals must complement those
services being provided through Health Branch and Mental Health agencies. The
Social Welfare Department was similarly involved.
The Medical Consultant and the Assistant Medical Consultant participated in
the postgraduate continuing medical education programmes sponsored through the
L 36 BRITISH COLUMBIA
university and the Provincial and local medical societies, as well as special and
pertinent continuing medical education seminars or courses offered outside British
Columbia.
The Medical Record Consultant serves in a consultatory capacity to the
British Columbia Hospital Insurance Service, and also to hospitals within the
Province. During the year, visits were made to hospitals, primarily to encourage
a high standard of medical record-keeping, in accordance with the guidelines offered
by the Canadian Council on Hospital Accreditation. Assistance was also given
to medical record personnel, with problems which related to the Medical Consultation Division. At the same time, emphasis was placed on the need for accuracy
and adequacy in the reporting of diagnoses and surgical procedures for coding
purposes. This ensures the production of meaningful statistical and research studies
undertaken by this Division and the Research Division. Plans for construction and
renovation projects for various hospitals were reviewed and assessed, according to
the workload within the respective medical record departments. Participation as a
member of the Provincial Education Committee of the British Columbia Association
of Medical Record Librarians ensured further liaison with medical record personnel.
ADMINISTRATIVE OFFICER
K. G. Wiper
The Administrative Officer is responsible for the drafting of
legislation, regulations, and Orders in Council for the British
Columbia Hospital Insurance Service. In the performance of
these duties, a close working relationship exists between this
office and the Attorney-General's Department.
Hospital societies may apply to the Administrative Officer
for assistance in connection with the drafting of hospital constitutions and by-laws, and their interpretation and application.
Changes in hospital by-laws were reviewed by this office prior to their submission for
Government approval as required under the Hospital Act. A set of model by-laws
has been developed for use by hospitals as a guide in making revisions.
Under the Regional Hospital Districts Act, described earlier in this Report, the
Administrative Officer worked closely with the officials of other departments and
of the various districts in arranging for money by-laws, temporary borrowing, and
related matters.
In collaboration with the Hospital Consultation and Inspection Division, the
Administrative Officer processes, for approval under section 14 of the Hospital Act,
transfers of private-hospital property and transfers of shares in the capital stock of
private-hospital corporations. In addition, close liaison is maintained with the Land
Registry Office to ensure that the property records of both general hospitals and
private hospitals are suitably endorsed so that land transfers are not made until they
are approved under sections 14 (2) and 41 (1) (c) of the Hospital Act.
As in previous years, considerable time was spent in 1969 on matters related
to the Federal-Provincial hospital insurance arrangements. Methods of streamlining
administrative procedures and improving liaison were discussed with officials of the
Federal Government and other Provinces at meetings held in Ottawa and Victoria.
The Administrative Officer is the Personnel Officer for the British Columbia
Hospital Insurance Service. He is also responsible for the over-all supervision of
the General Office and the Third Party Liability and the Eligibility Sections.
HOSPITAL INSURANCE SERVICE, 1969
L 37
Eligibility Representatives' Section
P. A. Bacon
In order to ensure that only qualified British Columbia residents receive hospital insurance benefits, the staff of the Eligibility Section review the Applications
for Benefits made by, or on behalf of, persons admitted to hospital. A detailed
check is made of all doubtful applications, resulting in the rejection of a considerable number of claims for hospital insurance benefits made by unqualified persons.
Numerous inquiries from the general public with regard to eligibility matters are
dealt with by personal interview, telephone, and correspondence.
Eligibility Representatives visit hospitals on a regular schedule to see that the
British Columbia Hospital Insurance Service eligibility procedures are being properly carried out. The Representatives also assist in the training of hospital admitting
personnel to deal with problems connected with the admission of patients to hospitals and the determination of their status under the Hospital Insurance Act. This
training assistance is provided by means of visits to hospitals and by regional
meetings.
This Section keeps the great majority of employers in British Columbia supplied with certificates on which an employee's length of employment can be certified.
The Representatives maintain close liaison with these firms to ensure their continuing co-operation in providing their employees with this form of proof of residence
for hospital insurance purposes.
Close liaison is maintained with the British Columbia Medical Plan, and Eligibility Representatives supply Medical Plan applications and information to the general public in many communities throughout the Province. Regional representatives
are located in Prince George, Kamloops, Nelson, and Kelowna, as well as in Vancouver and Victoria.
Third Party Liability Section
J. W. Brayshaw
The hospitalization reports that are completed by hospitals for every patient
admitted with accidental injuries are processed by the Third Party Liability Section.
This Section also handles the arrangements under which the British Columbia Hospital Insurance Service receives reimbursement from public liability insurance companies and self-insured corporations for hospital expenses paid by this Service on
behalf of accident victims. The Senior Eligibility Representative in Vancouver,
Mr. H. E. Drab, is responsible for maintaining a third-party liability clearing-house
for the convenience of solicitors and insurance adjusters in the Greater Vancouver
area. Up-to-date information regarding the hospitalization of accident victims is
available through the Vancouver office, and negotiations may be carried out in person or by telephone, thus avoiding the necessity of corresponding with the head
office in Victoria.
General Office
C. R. Leighton
The main responsibility of the General Office is the recording and accounting
of all receipts and expenditures connected with the internal administration of the
Hospital Insurance Service. This also includes preparation of the annual estimates,
which is done in conjunction with the Division Managers. This office is also
responsible for purchasing and distributing the office supplies and equipment used
by the Branch, and is generally responsible for maintenance and safe custody of
office machinery. In addition, the General Office handles the shipping of forms to
L 38 BRITISH COLUMBIA
hospitals and the sorting and distribution of mail. Stenographic services were
provided to the Public Information Office, and to other Divisions when the work
volume permitted. The Supervisor of this office is also the Safety Officer for the
Branch.
PUBLIC INFORMATION
R. H. Thompson
This office is responsible for the continuing development of public information
activities. Its three main areas of involvement are the general hospitals, the
general public, and in-service requirements. The following is a summary of the
work undertaken during 1969.
Hospital personnel continued to express increasing interest in the use of
films for in-service training, and during the year an estimated 4,000 hospital
personnel viewed 200 separate screenings of films available from the B.C.H.I.S.
library. Staff consultants previewed nine 16-mm. films and three series of 35-mm.
filmstrips, in order to assess their desirability as additions to the library. As a
result of their recommendations, the Service purchased five filmstrips, three which
deal with the dietary department, and two dealing with basic nursing. The availability of these films on a loan basis makes it unnecessary, in many instances, for
hospitals to purchase their own films for in-service training. In order to assist
B.C.H.I.S. in selecting the size and type of film which would be utilized to the
best advantage by the majority of hospitals, an Audio-Visual Aid Questionnaire
was developed and sent to hospitals in October. Eighty-four of the 104 hospitals
receiving the questionnaire completed and returned the form.
Updating of the B.C.H.I.S. Manual on Policy, Organization, and Procedures
was continued during the year, but difficulty was experienced in drafting a major
revision of the chapters dealing with hospital construction and planning, and hospital finance. The heavy volume of work, coupled with staff turnover, on the part
of the two Divisions concerned in the revision of this particular material, has delayed a complete rewrite of the chapters.
The two major pamphlets produced by B.C.H.I.S. were revised and reprinted
during the year. The " General Information " pamphlet, which is provided to new
residents of the Province, was received from the printers in November. The hospital pamphlet, " 24 Hours a Day," was revised with the assistance of the Administrator's Section of the British Columbia Hospitals' Association, and it was expected
that the reprint would be available for distribution at the year-end. At the request
of the Association, the B.C.H.I.S. material for their Trustee's Manual was also
revised, and 1,200 copies provided to the Association.
Regular editions of the B.C.H.I.S. Bulletin were published during the year and
distributed to all public and licensed private hospitals. The Bulletin is an administrative aid providing clarification on policy and procedural changes, as well as publishing items of general interest to hospitals.
Numerous press releases were issued during the year to ensure that the public
was kept informed regarding hospital construction programmes, policy changes, and
other items of general interest.
Other duties included the summarizing of reports for the information of the
Deputy Minister, maintaining the newspaper and hospital photograph files, replying to general correspondence, and the preparation and editing of the 21st Annual
Report.
HOSPITAL INSURANCE SERVICE, 1969
L 39
APPROVED HOSPITALS
Public Hospitals
Armstrong and Spallumcheen Hospital, Armstrong.
Arrow Lakes Hospital, Nakusp.
Bella Coola General Hospital, Bella Coola.
Boundary Hospital, Grand Forks.
British Columbia Cancer Institute, Vancouver.
Bulkley Valley District Hospital, Smithers.
Burnaby General Hospital, Burnaby.
Burns Lake and District Hospital, Burns
Lake.
Campbell River and District General Hospital, Campbell River.
Cariboo Memorial Hospital, Williams Lake.
Castlegar and District Hospital, Castlegar.
Chemainus General Hospital, Chemainus.
Children's Hospital, Vancouver.
Chilliwack General Hospital, Chilliwack.
Cowichan District Hospital, Duncan.
Cranbrook and District Hospital, Cranbrook.
Creston Valley Hospital, Creston.
Cumberland General Hospital, Cumberland.
Enderby and District Memorial Hospital,
Enderby.
Esperanza General Hospital, Esperanza.
Fernie Memorial Hospital, Fernie.
Fort Nelson General Hospital, Fort Nelson.
Fraser Canyon Hospital, Hope.
G. R. Baker Memorial Hospital, Quesnel.
Golden and District General Hospital, Golden.
Grace Hospital, Vancouver.
Kelowna General Hospital, Kelowna.
Kimberley and District Hospital, Kimberley.
Kitimat General Hospital, Kitimat.
Kootenay Lake General Hospital, Nelson.
Lady Minto Hospital, Ashcroft.
Lady Minto Gulf Islands Hospital, Ganges.
Ladysmith and District General Hospital,
Ladysmith.
Langley Memorial Hospital, Murrayville.
Lillooet District Hospital, Lillooet.
Lions Gate Hospital, North Vancouver.
McBride and District Hospital, McBride.
Maple Ridge Hospital, Haney.
Mater Misericordia? Hospital, Rossland.
Matsqui-Sumas-Abbotsford General Hospital,
Abbotsford.
Michel-Natal District Hospital, Michel.
Mills Memorial Hospital, Terrace.
Mission Memorial Hospital, Mission City.
Mount St. Joseph Hospital, Vancouver.
Nanaimo Regional General Hospital, Nanaimo.
Nicola Valley General Hospital, Merritt.
Ocean Falls General Hospital, Ocean Falls.
100 Mile District General Hospital, 100 Mile
House.
Peace Arch District Hospital, White Rock.
Penticton Hospital, Penticton.
Pouce Coupe Community Hospital, Pouce
Coupe.
Powell River General Hospital, Powell River.
Prince George Regional Hospital, Prince
George.
Prince Rupert General Hospital, Prince
Rupert.
Princeton General Hospital, Princeton.
Providence Hospital, Fort St. John.
Queen Alexandra Solarium for Crippled
Children, Victoria.
Queen Charlotte Islands General Hospital,
Queen Charlotte City.
Queen Victoria Hospital, Revelstoke.
Rest Haven Hospital and Sanitarium, Sidney.
Richmond General Hospital, Richmond.
Royal Columbian Hospital, New Westminster.
Royal Inland Hospital, Kamloops.
Royal Jubilee Hospital, Victoria.
R. W. Large Memorial Hospital, Bella Bella.
St. Bartholomew's Hospital, Lytton.
St. George's Hospital, Alert Bay.
St. John Hospital, Vanderhoof.
St. Joseph General Hospital, Dawson Creek.
St. Joseph's General Hospital, Comox.
St. Joseph's Hospital, Victoria.
St. Martin's Hospital, Oliver.
St. Mary's Hospital, New Westminster.
St. Mary's Hospital, Sechelt.
St. Paul's Hospital, Vancouver.
St. Vincent's Hospital, Vancouver.
Shuswap Lake General Hospital, The, Salmon Arm.
Slocan Community Hospital, New Denver.
Squamish General Hospital, Squamish.
Stewart General Hospital, Stewart.
Summerland General Hospital, Summerland.
Surrey Memorial Hospital, North Surrey.
Torino General Hospital, Torino.
Trail Regional Hospital, Trail.*
University Health Service Hospital, University of British Columbia, Vancouver.
University of British Columbia Health Sciences Centre Hospital, Vancouver.
Vancouver General Hospital, Vancouver.
Vernon Jubilee Hospital, Vernon.
Victorian Hospital, Kaslo.
West Coast General Hospital, Port Alberni.
Windermere District Hospital, Invermere.
Wrinch Memorial Hospital, Hazelton.
! Name changed from Trail-Tadanac Hospital on December 2, 1969.
L 40 BRITISH COLUMBIA
Outpost Hospitals
Red Cross Outpost Nursing Station, Alexis Red Cross Outpost Nursing Station, Edge-
Creek, wood.
Red Cross Outpost Nursing Station, Atlin. Red Cross Outpost Nursing Station, Kyuquot.
Red Cross Outpost Nursing Station, Bam- Red Cross Outpost Nursing Station, Masset.
field. Red Cross Outpost Nursing Station, Wad-
Red Cross Outpost Nursing Station, Blue hams.
River.
Federal Hospitals
Veterans' Hospital, Victoria. Miller Bay Indian Hospital, Prince Rupert.
Shaughnessy Hospital, Vancouver. R.C.A.F. Station Hospital, Holberg.
Coqualeetza Indian Hospital, Sardis.
Licensed Private Hospitals
Industrial Hospitals in Remote Areas with Which the Province Has Entered into
an Agreement Requiring Them to Furnish the General Hospital Services
Provided under the Hospital Insurance Act.
Bralorne Private Hospital, Bralorne. Mica Creek Private Hospital, Mica Creek.
Cassiar Asbestos Corporation Private Hos- Port Alice Private Hospital, Port Alice,
pital, Cassiar.
Other
Hollywood Hospital Ltd., New Westminster (licensed under the Mental Health Act).
Rehabilitation, Chronic, and Convalescent Hospitals
G. F. Strong Rehabilitation Centre, Vancou- Shaughnessy Hospital, Vancouver.
ver- Sunny Hill Hospital for Children, Vancou-
The Gorge Road Hospital, Victoria. ver
Holy Family Hospital, Vancouver Veterans' Hospital, Victoria.
Pearson Hospital (Poliomyelitis Pavilion), i , . ,
Vancouver ' number of the larger public hospitals
Queen Alexandra Solarium for Crippled also have rehabilitation units.)
Children, Victoria.
Extended-care Hospitals
Mount St. Mary Hospital, Victoria (exclud- Pearson Hospital, Vancouver (excluding fa-
ing top floor). cilities for tuberculosis patients).
Mount St. Francis Hospital, Nelson. The Louis Brier Hospital, Vancouver.
Mount St. Joseph Hospital, Vancouver (top Valleyhaven Hospital, Chilliwack.*
floor). Veterans' Hospital, Victoria (extended-care
Menno Hospital, Abbotsford. unit).
Priory Hospital, Colwood (24-bed unit and Shaughnessy Hospital, Vancouver (extended-
71-bedunit). care unit).
* Became part of the Chilliwack General Hospital in 1969.
HOSPITAL INSURANCE SERVICE, 1969
L 41
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.
L 42 BRITISH COLUMBIA
In 1969 there were 91 public general hospitals approved to accept British
Columbia Hospital Insurance Service patients. Care was also provided in seven
outpost hospitals, five Federal hospitals, five contract hospitals, five public rehabilitation hospitals, and one rehabilitation hospital operated by the Provincial Government. Hospital insurance coverage for patients in non-profit extended-care hospitals
and units commenced December 1, 1965. At the end of 1969 there were 25 hospitals providing extended care. Data for the year 1969 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 1a shows a total of 339,600 British Columbia Hospital Insurance Service
adult and children patients were separated (discharged) from British Columbia
hospitals in 1969, an increase of 14,831 or 4.6 per cent over 1968. This table also
shows that 95.6 per cent of the total patients separated (discharged) from British
Columbia public hospitals were covered by hospital insurance, compared to 95.3
in 1967 and 95.7 in 1968. Table 1b indicates in 1969 that the British Columbia
Hospital Insurance Service paid public hospitals in British Columbia for 3,141,100
days of care for adults and children, an increase of 66,141 days or 2.1 per cent
over 1968.
As shown in Table 2a, the average length of stay of British Columbia adult and
children patients in public hospitals during 1969 was 9.25 days, and the days of
care per thousand population were 1,769. For comparison purposes, the data for
extended-care hospitals is not included in the above observations, but it should be
noted that an additional 243 days of care per thousand population were provided
for these patients.
Table 2b, under " Minor Surgery Patients," includes an estimated 19,000 daycare surgery and psychiatric patients. An additional estimated 30,000 out-patient
cancer treatments were covered by the British Columbia Hospital Insurance Service,
which are not included in this table.
J
HOSPITAL INSURANCE SERVICE, 1969
L 43
Table 1a. — Patients Separated (Discharged or Died) and Proportion
Covered by British Columbia Hospital Insurance Service, British
Columbia Public Hospitals Only (Excluding Federal, Private, and
Out-of-Province Hospitalization) (Including Rehabilitation Hospitals).
Total Hospitalized in Public
Hospitals
Covered by B.C.H.I.S.
Adults
and
Children
Newborn
Total
Adults
and
Children
Newborn
Total
Patients separated—
1949
164,964
216,743
261,128
271,609
277,073
285,998
292,119
301,510
314,585
326,793
338,923
354,800
26,272
33,190
39,599
38,226
37,697
37,231
35,688
33,555
32,488
32,014
33,529
35,200
191,236
249,933
300,727
309,835
314,770
323,229
327,807
335,065
347,073
358,807
372,452
390,000
140,168
199,774
249,654
259,953
264,655
272,597
278,023
286,799
299,518
311,718
324,769
339,600
84.9
92.2
95.6
95.7
95.5
95.3
95.2
95.1
95.2
95.4
95.8
95.7
24,640
31,515
38,980
37,558
36,505
35,878
34,196
31,863
30,814
30,377
31,635
33,300
93.8
95.0
98.4
98.3
96.8
96.4
95.8
95.0
94.8
94.9
94.4
94.6
164,808
1955
231,289
1960
288,634
1961
297,511
196?
301,160
1963
308,475
1964
312,219
1965
318,662
1966
330,332
1967
19681
19692
342,095
356,404
372,900
Percentage of total, patients separated—
1949
86.2
1955 ._
92.5
I960
96.0
1961
96.0
196?
95.7
1963
95.4
1964
95.2
1965 _ _
95.0
1966
95.2
1967
95.3
19681... .
95.7
19692...
95 6
1
i Amended as per final reports received from hospitals.
2 Estimated, based on hospital reports to October 31,1969.
L 44
BRITISH COLUMBIA
Table 1b.—Total Patient-days and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public Hospitals
Only (Excluding Federal, Private, and Out-of-Province Hospitalization) (Including Rehabilitation Hospitals).
Total Hospitalized
Hospitals
in Public
Covered by B.C.H.I.S.
Adults
and
Children
Newborn
Total
Adults
and
Children
Newborn
Total
Patient-days—
1949
1,682,196
2,198,863
2,581,042
2,675,402
2,708,337
2,778,668
2,820,122
2,895,476
3,008,632
3,093,372
3,225,333
3,297,900
213,874
227,674
249,273
240,207
274,032
270,298
260,979
245,756
235,796
239,972
244,715
248,300
1,896,070
2,426,537
2,830,315
2,915,609
2,982,369
3,048,966
3,081,101
3,141,232
3,244,428
3,333,344
3,470,048
3,546,200
1,430,646
2,005,165
2,451,839
2,546,344
2,573,634
2,631,671
2,670,176
2,747,232
2,861,260
2,946,000
3,074,959
3,141,100
85.0
91.2
95.0
95.2
95.0
94.7
94.7
94.0
95.1
95.2
95.3
95.2
200,585
212,514
241,157
231,043
263,475
257,736
246,813
230,096
220,270
222,543
226,633
232,300
93.8
93.3
96.7
96.1
96.1
95.4
94.6
93.0
93.4
92.7
92.6
93.5
1,631,231
los";
2,217,679
1960 ... -
2,692,996
1961
2,777,387
1°62
2,837,109
2,889,407
1963
1"64
2,916,989
2,977,328
1Q65
1966
3,081,530
3,168,543
3,301,592
3,373,400
86 0
1°67
19681
JQ6Q2
Percentage of total, patient-days—
1Q/JO
1955 ..
91.4
1960
95.1
1961
95.3
1062
95.1
1963 _~ -
94.8
1«64
94.7
1965
94.0
1966 -
95.0
1967
95 0
19681
95 1
19692
95 1
i Amended as per final reports received from hospitals.
2 Estimated, based on hospital reports to October 31, 1969.
HOSPITAL INSURANCE SERVICE, 1969
L 45
Table 2a.—Patients Separated, Total Patient-days, and Average Length
of Stay According to Type and Location of Hospital for B.C.H.I.S.
Patients Only, and Days of Care per Thousand of Covered Population.
Total
(Excluding
Extended Care)
Adults
and
Children
Newborn
B.C. Public
Hospitals
Adults
and
Children
Newborn
Other B.C. Hospitals,
Including Federal
and Private
Adults
and
Children
Newborn
Institutions
Outside B.C.
Adults
and
Children
Newborn
Extended-
care
Hospitals
(Including
Federal)
Patients separated-
1949
1955
1960
1961
1962
1963
1964
1965
1966..
1967..
19681-
19692
Patient-days—
1949
1955
1960
1961
1962
1963
1964
1965
1966..
1967...
19681
19692
Average days of
stay—
1949
1955
1960
1961
1962
1963
1964
1965
1966...
1967....
1968L.
19692..
149,280
209,999
264,120
273,293
278,021
286,753
293,144
301,522
314,391
325,861
338,706
353,746
1,498,121
2,100,386
2,650,129
2,756,665
2,789,355
2,850,559
2,905,544
2,985,092
3,110,701
3,189,212
3,309,533
3,398,838
24,989
32,035
39,488
37,968
36,942
36,326
34,652
32,240
31,152
30,804
32,031
33,683
203,197
215,980
j 244,480
| 233,794
| 266,351
| 260,771
| 249,827
I 232,438
| 222,475
| 225,479
| 229,053
| 234,497
1
10.03
10.00
10.03
10.09
10.03
9.94
9.91
9.90
9.89
9.79
9.77
9.61
8.13
6.74
6.19
6.16
7.21
7.18
7.21
7.21
7.14
7.32
7.15
6.96
140,168
199,774
249,654
259,953
264,655 I
272,597 j
278,023 |
286,799 I
299,518
311,718
324,769
339,600
1,430,646
2,005,165
2,451,839
2,546,344
2,573,634
2,631,671
2,670,176
2,747,232
2,861,260
2,946,000
3,074,959
3,141,100
10.21
10.04
9.82
9.80
9.72
9.65
9.60
9.57
9.55
9.45
9.47
9.25
24,640
31,515
38,980
37,558
36,505
35,878
34,196
31,863
30,814
30,377
31,635
33,300
200,585
212,514
| 241,157
| 231,043
| 263,475
| 257,736
| 246,813
| 230,096
220,270
222,543
226,633
232,300
8.14
6.74
6.19
6.15
7.22
7.18
7.22
7.22
7.15
7.32
7.16
6.98
7,093
8,313 |
11,557 |
10,361 |
10,226 |
10,895
11,605
11,417
11,459
9,436
9,310
8,986
45,960
75,599
169,401
182,690
183,042
187,714
199,164
205,488
212,413
195,564
188,152
204,238
6.48
9.09
14.66
17.63
17.90
17.23
17.16
18.00
18.53
20.72
20.21
22.73
I
I
151
361
241
151
157
169
149
114
101
83
80
83
1,146
2,271
1,417
878
850
1,018
878
619
541
451
434
397
7.59
6.29
5.88
5.81
5.41
6.02
5.89
5.43
5.36
5.43
5.42
4.78
2,019
1,912
2,909
2,979
3,140
3,261
3,516
3,306
3,414
4,707
4,627
5,160
21,515
19,622
28,889
27,631
198
159
267 I
259
280
279
307
263
237
344
316
300
1,466
1,195
1,906
1,873
32,679 I 2,026
31,174 | 2,017
36,204 1 2,136
32,372
1,723
37,028
1,664
47,648
2,485
46,422
1,986
53,500
1,800
10.66
7.40
10.26
7.52
9.93
7.14
9.27
7.23
10.41
7.24
9.56
7.23
10.30
9.79 |
10.84
10.12
10.03
10.37
I
6.96
6.55
7.02
7.22
6.28
6.00
699
873
990
1,120
305,940
358,675
409,514
500,000
437.68
410.85
413.64
446.43
i Amended as per final reports from hospitals.
2 Estimated, based on hospital reports to October 31, 1969. Estimated patient-days (including newborn
days) per thousand of population covered by British Columbia Hospital Insurance Service: 1949, 1,528; 1950,
1,548; 1951, 1,496; 1952, 1,527; 1953, 1,600; 1954, 1,733; 1955, 1,720; 1956, 1,688; 1957, 1,626; 1958, 1,665;
1959, 1,724; 1960, 1,804; 1961, 1,806; 1962, 1,841; 1963, 1,835; 1964, 1,815; 1965, 1,799; 1966, 1,779; 1967,
1,754; 1968, 1,774; 1969, 1,769. (1954 and subsequent years are based on total population. Because the Armed
Forces, Royal Canadian Mounted Police, and some other groups are not insured under the Provincial plan, the
actual incidence of days would be somewhat higher than shown.) In addition, estimated patient-days per
thousand population for extended care amounted to 205 in 1968 and 243 in 1969. Population figures are
revised according to latest census figures.
L 46
BRITISH COLUMBIA
Table 2b.—Summary of the Number of B.C.H.I.S. In-patients (Including
Extended Hospital Care Patients) and Short-stay Patients
Total Adults,
Children, and
Newborn
In-patients
Estimated
Number of
Emergency and
Minor-surgery
Patients i
Total
Receiving
Benefits
1<M9
174,269
242,034
303,608
311,261
314,963
323,079
327,796
333,762
346,242
357,538
371,727
388,549
29,000
70,553
107,312
121,000
128,000
135,000
Ml ,000
160,000
175,000
195,000
210,000
220,000
203,269
312,587
410,920
1955
1Q«1
1961 ... . . ..
19ft?
432,261
442,963
458,079
468,796
1963
1964 - ..
1965
1966 ...
1967
19682 _ ,
19693
493,762
521,242
552,538
581,727
608,549
Totals
5,862,012 2,299,073
1
8,161,085
1 Years 1962 to 1969 estimated, includes day-care surgery.
2 Amended as per final reports received from hospitals.
s Estimated, based on hospital reports to October 31, 1969.
Table 3.—Patients Separated, Total Days' Stay, and Average Length of
Stay in British Columbia Public Hospitals for B.C.H.I.S. Patients
Only, Grouped According to Bed Capacity, Year 19691 (Excluding
Extended-care Hospitals) .
Bed Capacity
Total
250 and
Over
100 to 249
50 to 99
Under 25
Patients separated—
Adults and children
Newborn .
Patient-days—
Adults and children
Newborn
Average days of stay-
Adults and children
Newborn
339,600
33,300
3,141,100
232,300
9.25
6.98
149,100
13,300
1,506,800
99,500
10.10
7.48
93,400
10,300
793,300
68,800
8.49
6.68
54,200
6,400
519,000
43,200
9.58
6.75
34,300
2,650
256,500
16,100
7.48
6.08
8,600
650
65,500
4,700
7.62
7.23
1 Estimated, based on hospital reports to October 31, 1969.
Table 4.—Percentage Distribution of Patients Separated and Patient-
days for B.C.H.I.S. Patients Only, in British Columbia Public Hospitals, Grouped According to Bed Capacity, Year 19691 (Excluding
Extended-care Hospitals) .
Bed Capacity
Total
250 and
Over
100 to 249
50 to 99
25 to 49
Under 25
Patients separated—
Adults and children
Newborn .
Patient-days—
Adults and children
Newborn
Per Cent
100.00
100.00
100.00
100.00
Per Cent
43.91
39.94
47.97
42.83
Per Cent
27.50
30.93
25.26
29.62
Per Cent
15.96
19.22
16.52
18.60
Per Cent
10.10
7.96
8.17
6.93
Per Cent
2.53
1.95
2.08
2.02
1 Estimated, based on hospital reports to October 31, 1969.
HOSPITAL INSURANCE SERVICE, 1969
L 47
CHARTS
The statistical data shown in the following charts prepared by the Research
Division are derived from Admission/Separation forms submitted to the British
Columbia Hospital Insurance Service.
The major diagnostic categories used for the table on pages 53 to 56 are more
detailed than the diagnostic groups shown on the charts. Both lists are based on
the International Classification of Diseases, Adapted, prepared by the Public Health
Service of the United States Department of Health, Education, and Welfare.
Readers who are interested in more detailed statistics of hospitalization in this
Province may wish to refer to " Statistics of Hospital Cases Discharged during 1968 "
and " Statistics of Hospitalized Accident Cases, 1968 " available from the Research
Division.
L 48
BRITISH COLUMBIA
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BRITISH COLUMBIA
Chart V.—Average Length of Stay of Cases* in Hospitals in British
Columbia, by Major Diagnostic Groups in Descending Order, 1968
(Excluding Newborns).
Diseases of the circulatory system
Diseases of the bones and
organs of movement
Neoplasms
Diseases of the blood and
blood-forming organs
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and sense organs
Congenital malformations
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personality disorders
Allergic, endocrine system,
metabolic, and nutritional diseases
Infective and parasitic diseases
Injuries and adverse effects
Certain diseases of early infancy
Diseases of the skin and
cellular tissue
PROVINCIAL AVERAGE
LENGTH OF STAY
Diseases of the digestive system
Diseases of the genito-urinary
system
Diseases of the respiratory system
Deliveries and complications of
pregnancy, childbirth, and the
puerperium
Symptoms, senility, and ill-
defined conditions
Supplementary classification for
special admissions
* Including rehabilitative care.
K
HOSPITAL INSURANCE SERVICE, 1969
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HOSPITAL INSURANCE SERVICE, 1969 L 57
STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR THE
FISCAL YEAR ENDED MARCH 31, 1969
Administration—
Salaries
Temporary assistance
Office expense
Travelling expense
Office furniture and equipment
Printing and publications
Tabulating and rentals
Motor-vehicles and accessories
Incidentals and contingencies
Construction and consultation fees
Technical surveys
Payments to hospitals
Grants in aid of construction
Total
$769,020.00
5,528.00
$774,548.00
50,081.00
49,163.00
6,661.00
3,739.00
4,034.00
2,153.00
1,905.00
71.00
38,843.00
$931,198.00
134,679,028.00
3,251,920.00
$138,862,146.00
Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1970
750-1169-9458
BC Sessional Papers
Twenty-first Annual Report British Columbia Hospital Insurance Service JANUARY 1 TO DECEMBER 31 1969 British Columbia. Legislative Assembly 1970
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