PROVINCE OF BRITISH COLUMBIA HOSPITAL INSURANCE ACT Twenty-second Annual Report British Columbia Hospital Insurance Service JANUARY 1 TO DECEMBER 31 1970 Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1971 Victoria, British Columbia, January 21, 1971. 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-second Annual Report of the British Columbia Hospital Insurance Service covering the calendar year 1970. RALPH R. LOFFMARK Minister of Health Services and Hospital Insurance British Columbia Hospital Insurance Service, Victoria, British Columbia, January 21, 1971. The Honourable Ralph R. Loffmark, Minister of Health Services and Hospital Insurance, Parliament Buildings, Victoria, British Columbia. Sir—I have the honour to present herewith the Report of the British Columbia Hospital Insurance Service covering the calendar year 1970. 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. H 0. < o H < N Z < a o. o <z [_.«< OB* __u^ oS-tn W__Z H*& enul . "S.<n J z_< 2lH _C CS a a at 3TJ u c P 3 a a o o a> a c c «Q c C rt 0, o __; c > X «s Q u r_ =S__e ■go^o 3.5.5 fS-gQ C3 CO "3 3 a ™ rt 3 a> « <2o 3° £4" H J. w a"5 ■-6 2 orr u .- c 2 ft_ = 36_= PU OO OCO ■OT3'?, £05 2U« tn O •aO _ >>_. 2 EKE ■;_ _>™ ^a1-* o u, c •" s &si " SQ<5 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, Senior Administrative Officer. P. Breel, Manager, Hospital Consultation and Inspection Division. Wm. E. Selwood, B.A., Acting Director, Research Division. J. G. Glenwright, Manager, Hospital Construction and Planning Division. D. M. N. Longridge, M A., B.Ch., F.R.C.S., Assistant Medical Consultant. CONTENTS Page Organization Chart 8 General Introduction 13 British Columbia Regional Hospital Districts Act 15 British Columbia Regional Hospital Districts Financing Authority Act 16 The Hospital Insurance Act 16 The Hospital Act 16 Persons Entitled to or Excluded From the Benefits Under the Hospital Insurance Act 17 Entitled to Benefits 17 Excluded From Benefits 17 Hospital Benefits Available in British Columbia 18 In-patient Benefits 18 Other Benefits 18 Application for Hospital Insurance Benefits 19 The Hospital Rate Board and Methods of Payment to Hospitals 19 BCHIS Planning Group 20 Organization and Administration 21 Assistant Deputy Minister 22 Hospital Finance Division 22 Hospital Accounting 23 Hospital Claims Section 24 Hospital Construction and Planning Division 26 Hospital Projects Completed During 1970 28 Hospital Projects Under Construction at Year-end 29 Projects in Advanced Stages of Planning 30 Additional Projects Approved and in Various Planning Stages in 1970 30 Director of Hospital Consultation, Development, and Research 34 Hospital Consultation and Inspection Division 34 Research Division 35 Medical Consultation Division 36 Administrative Officer 3 8 Eligibility Representatives' Section 3 8 Third-party Liability Section 39 General Office 3 9 Information Office 40 11 P 12 BRITISH COLUMBIA Page Approved Hospitals 41 Public Hospitals 41 Outpost Hospitals 42 Federal Hospitals 42 Private Hospitals (Providing General Hospital Services) 42 Rehabilitation Hospitals 42 Extended-care Hospitals 42 Statistical Data 43 Table 1a—Patients Separated and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public General Hospitals Only (Excluding Federal, Private, Extended-care, and Out-of- Province Hospitalization) 45 Table 1b—Total Patient-days and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public General Hospitals Only (Excluding Federal, Private, Extended-care, and Out-of- Province Hospitalization) 46 Table 2a—Patients Separated, Total Days' Stay, and Average Length of Stay According to Type and Location of Hospital for BCHIS Patients Only, and Days of Care per Thousand of Covered Population 47 Table 2b—Summary of the Number of BCHIS In-patients and Outpatients 48 Table 3—Patients Separated, Total Days' Stay, and Average Length of Stay in British Columbia Public Hospitals for BCHIS Patients Only, Grouped According to Bed Capacity, Year 1970 (Excluding Extended-care Hospitals) 4 8 Table 4—Percentage Distribution of Patients Separated and Patient-days for BCHIS Patients Only, in British Columbia Public Hospitals. Grouped According to Bed Capacity, Year 1970 (Excluding Extended-care Hospitals ) 4 8 Charts 49 I—Percentage Distribution of Days of Care by Major Diagnostic Groups, 1969 50 II—Percentage Age Distribution of Male and Female Hospital Cases and Days of Care, 1969 51 III—Percentage Distribution of Hospital Cases by Type of Clinical Service, 1969 52 IV—Percentage Distribution of Hospital Days by Type of Clinical Service, 1969 53 V—Average Length of Stay of Cases in Hospitals in British Columbia by Major Diagnostic Groups, 1969 (Excluding Newborns) 54 Hospitalization by Major Diagnostic Categories, 1969 (Excluding Newborns) 55 Statement of Receipts and Disbursements for the Fiscal Year Ended March 31, 1970 61 Twenty-second 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 has now completed 22 years of operation. Those years have been marked by development of hospital services and hospital insurance protection for the people of the Province far in excess of anything that would have been possible without a Government- operated hospital insurance programme. The information from the divisions of the Service appearing later in this Report provide a brief summary of what was accomplished during 1970. The record is a tribute to the policy direction of the Government and the efforts of the boards, administration, and staffs of hospitals; the medical profession; the women's auxiliaries; and the boards of regional hospital districts. I would be remiss if I did not acknowledge here the skilled and devoted work of the staff of the British Columbia Hospital Insurance Service. It is my considered opinion that the staff of the Service is outstanding among fine hospital insurance service staffs in Canada. During the year, British Columbia Hospital Insurance Service payments to hospitals reached an all-time high of an estimated $182,500,000, which is the equivalent of $84.23 being paid on behalf of each man, women, and child living in British Columbia at the present time. Hospital insurance daily payments to hospitals amounted to $490,410, as compared to $432,232 in the 1969/70 fiscal year, an increase of 13.6 per cent. The report of the Hospital Construction Division describes the continued progress in British Columbia's programme of hospital construction. Unfortunately, work stoppages delayed seriously a number of essential projects. Building programmes under way at year-end, many due for completion early in 1971, will cost an estimated $60,442,394, and projects in the advanced stages of planning represent an additional $33,353,930 in capital expenditure. The major projects completed during the year involved a total of 589 new beds, of which 203 were for extended care. In addition, 1,302 beds were under construction at year-end, with 573 for extended care. Communities which witnessed completion of building programmes, including major construction, renovations, and alterations in 1970, were Creston, Kamloops, Kelowna, Murrayville, Princeton, Revelstoke, Surrey, Trail, and Victoria. Centres in which construction projects are currently under way included Burns Lake, Chetwynd, Chilliwack, Golden, Kelowna, Mackenzie, Nanaimo, North Vancouver, Ocean Falls, Penticton, Port Alberni, Prince Rupert, Richmond, Salmon Arm, Sechelt, and Surrey. It is anticipated the majority of these projects will be completed during 1971. 13 P 14 BRITISH COLUMBIA In 1970, coverage under the Hospital Insurance Service was extended to include a cytology service as an out-patient benefit. The cytology programme provides a laboratory service of great value in the early detection of cancer in women. The service, formerly under the administration of the Vancouver General Hospital, is now under the supervision of the British Columbia Cancer Institute. Provision was also made during the year for coverage as an insured benefit of out-patient and day-care psychiatric services in selected hospitals. Such coverage provides a tremendous step in the over-all psychiatric-care programme, as it enables a person to return to his home after receiving treatments instead of remaining in hospital. These services are a very worth-while benefit to the public and represent a concept of care considered to provide an efficient way of reducing pressure on inpatient hospital beds. The hospitals authorized to make available these insured benefits were Vancouver General; Royal Jubilee, Victoria; Lions Gate, North Vancouver; and the Prince George Regional Hospital. Prior to this the only coverage for psychiatric out-patient and day-care services was at the pilot project in the Health Sciences Centre Hospital at the University of British Columbia. The Government also gave approval for construction of a number of diagnostic and treatment centres to provide emergency and out-patient services to communities located at a distance from hospitals and with sufficient population to support a physician's practice. In early April, two members of the Australian Medical Association—Dr. Nicholas Larkins, secretary, and Dr. Lionel Wilson, council member—visited with British Columbia Hospital Insurance Service officials to inquire in broad terms into the relationship of the practising medical profession with the hospital service in British Columbia, and payment for physicians' services under the Canadian system. They also looked at the organization of hospital accreditation and the whole question of general practitioner access to hospitals, the role played in hospitals by general practitioners and the training of these practitioners. Another distinguished visitor inquiring about our services was William Naylor, Secretary and Chief Administrative Officer of the Sheffield Regional Hospital Board, Sheffield, England, who came here in June. As in previous years, members of our senior staff were invited to attend the British Columbia Hospitals' Association Convention held in Vancouver in October. We are always grateful for the opportunity the conference presents to meet with representatives of the board of management, administrators, and nursing service from hospitals throughout the Province. In all, 66 meetings were held with hospital delegations during the three days. During the year, the audio-visual and stockroom staffs of the Provincial Health Branch helped us with photography, printing, and films. This has meant a saving to Hospital Insurance, as otherwise it would have been necessary to have much of the work done outside. The assistance of the other departments of the Provincial Government, which is always so readily available, was of tremendous value to our Service. The close working relationship that prevails with the Deputy Minister of Health and the Deputy Minister of Mental Health and their staffs, and the steps taken by the Minister of Health Services and Hospital Insurance to encourage that relationship, are particularly gratifying. There is an equally good relationship with the Chairman, Medical Services Commission and the staff of the Commission and the British Columbia Medical Plan. It gives me great pleasure once again to express my sincere appreciation for the advice and guidance by the College of Physicians and Surgeons, the British HOSPITAL INSURANCE SERVICE, 1970 P 15 Columbia Medical Association, the medical profession generally, and for the continuing assistance of the British Columbia Hospitals' Association and the Registered Nurses' Association of British Columbia. The work of the Laboratory and Radiological Advisory Councils was again of inestimable value in assisting hospitals to improve their laboratory and radiological service and in advising the British Columbia Hospital Insurance Service regarding the approval of Provincial grants-in-aid for the purchase of hospital equipment. Reports submitted by the various divisions which comprise the administrative structure of our Branch appear under "Organization and Administration," commencing on page 21. 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. r P 16 BRITISH COLUMBIA A hospital society or corporation is not compelled to seek financing under this new Act. In situations where the community's share of the cost can be, or has already been, raised by other means, a Provincial Government grant under the old 50-per-cent formula can be applied for under the procedure which was applicable up to this time. BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS FINANCING AUTHORITY ACT This Act establishes a Provincial Government authority similar to the one set up a few years ago to assist school districts in financing their projects. The functions of the Authority are referred to briefly in the second paragraph of the preceding commentary regarding the Regional Hospital Districts Act. 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 illnes 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 out-patient benefits, which include emergency, minor surgery, day-care surgical, cancer therapy, psychiatric, cytology, and rehabilitative 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—nonprofit hospitals caring primarily for acutely ill persons. HOSPITAL INSURANCE SERVICE, 1970 P 17 (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 BCHIS coverage. (3) Rehabilitation and extended-care hospitals. These are nonprofit hospitals approved under Part III of the Hospital Act, primarily for the treatment of persons who will benefit from intensive rehabilitative and extended hospital care. PERSONS ENTITLED TO OR EXCLUDED FROM THE BENEFITS UNDER THE HOSPITAL INSURANCE ACT Entitled to Benefits A person is entitled to benefits if he qualifies as a beneficiary under the Hospital Insurance Act. Generally speaking, a person is a beneficiary if the provision of hospital care is a medical necessity, and if he establishes that he qualifies under one of the following categories: (a) He is the head of a family, or a single person, who has made his home in the Province and has lived continuously therein during the preceding three consecutive months; or (b) Having qualified under item (a), he leaves the Province temporarily and returns after an absence of less than 12 months and resumes residence within the Province; or (c) He is living within the Province and is a dependent of a resident of the Province. During the three-month residence qualification period, a person is permitted to be temporarily absent from British Columbia for a brief period without incurring any postponement of the date on which he becomes a beneficiary. With regard to item (c) above, a dependent is either the spouse of the head of a family or a child under 21 years of age who is mainly supported by the head of a family. Excluded From Benefits Some of the main classes of persons either permanently or temporarily excluded from benefits are as follows: (a) A person who works full or part time in British Columbia but who resides outside the Province; or (b) A qualified person who leaves British Columbia temporarily and fails to return and re-establish residence within 12 months; or (c) A qualified person who leaves British Columbia and who establishes residence elsewhere; or (d) An inmate of a Federal penitentiary; or (e) A resident who receives hospital treatment provided under the Workmen's Compensation Act, or a war veteran who receives treatment for a pensionable disability; or (/) Persons entitled to receive hospital treatment under the Statutes of Canada or any other government; for example, members of the Armed Forces or Royal Canadian Mounted Police, and consular officials of other countries. P 18 BRITISH COLUMBIA HOSPITAL BENEFITS AVAILABLE IN BRITISH COLUMBIA In-patient Benefits In addition to standard-ward accommodation with meals and necesary nursing services, a beneficiary may receive any of the other services available in the hospital, which may include: Laboratory and X-ray services. Drugs, biologicals, and related preparations (with a few exceptions). Use of operating-room and caseroom facilities. Use of anaesthetic equipment, supplies, and routine surgical supplies. Use of radiotherapy and physiotherapy facilities where available. Other approved services rendered by employees of the hospital. (Note.—Private or semiprivate 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.) Other Benefits 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. Out-patient cancer therapy is provided by the branches of the B.C. Cancer Institute in Vancouver and Victoria. Day-care and night-care psychiatric services are available to patients who come to hospital for an organized programme of treatment which requires that they remain for a minimum of seven hours, but does not necessitate formal admission as in-patients. Out-patient psychiatric care is available to patients who come to the hospital only for a particular psychiatric service. (During 1970 the number of hospitals authorized to provide day-care and out-patient psychiatric services as insured benefits was increased.) A cytology service, formerly handled with grants from the Health Branch, was transferred to BCHIS during the year. This service provides for examination by cervical smears for the early detection of cancer in women. The service is operated by the B.C. Cancer Institute and is universally available for residents of the Province. Day-care rehabilitative services at the G. F. Strong Rehabilitation Centre in Vancouver apply to patients requiring an organized and comprehensive programme of treatment which would require that they remain at the centre for at least a half day. A beneficiary is required to pay a nominal sum for each visit to the hospital for these services, and the remainder of the cost is paid by the British Columbia Hospital Insurance Service. Charges for medical services incurred at the hospital are not payable by the British Columbia Hospital Insurance Service, and nonbeneficiaries are required to pay the full charge for the hospital services and treatment received. HOSPITAL INSURANCE SERVICE, 1970 P 19 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 TO HOSPITALS AND METHODS OF PAYMENT 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, with modifications, 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. However, hospitals retain surplus funds earned as a result of keeping expenditures within the total amount approved. The value of variable supplies used in patient-care has been established. It is generally recognized that the addition of a few more patient-days does not add proportionately to patient-day costs because certain overhead expenses (such as heating, etc.) are not affected. However, some additional supplies will be consumed, and it is the cost of these variable supplies which has been determined. When the number of days' treatment provided by the hospital differs from the estimated occupancy, the budgets are increased or decreased by the number of days' difference multiplied by the patient-day value of the variable supplies. Individual studies and additional budget adjustments are made in those instances where large fluctuations in occupancy involve additions or reductions in stand-by costs. Policies to be used in the allocation of the total funds provided are approved by the Government. The Hospital Rate Board reviews the detailed revenue and expenditure estimates forwarded by each hospital and applies the policies in establishing approved budgets. 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 semimonthly basis, so that hospitals are not required to wait for payment until patients' accounts are submitted and processed by the British Columbia Hospital Insurance Service. Qualified patients are charged $1 per day, which is deductible when calculating payments to hospitals from the Service. Nonqualifying residents are charged the hospitals' established per diem rates, which are all-inclusive; that is, the daily rate covers the cost of all the regular hospital services, such as X-ray, laboratory, operating-room, etc., provided to patients, in addition to bed, board, and nursing care. HOSPITAL INSURANCE SERVICE, 1970 P 21 BCHIS 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 27 meetings held during the year, six were with outside groups. Detailed discussions were held with the Advisory Committee of the Greater Vancouver Regional Hospital District regarding a number of programmes and studies initiated by that district. There was increased activity by regional hospital districts in planning total hospital programmes to meet district needs, reflecting a trend evident in 1969. As recommended by the Planning Group, teams from the Service acted as consultants to the boards of the East Kootenay, Central Kootenay, and Comox-Strathcona Regional Hospital Districts to assist them in devising over-all programmes. The Service was also represented on the directing group of a study of health needs initiated by the Kitimat-Stikine Regional Hospital District. The Planning Group worked with other regional hospital districts in developing comprehensive programmes on which money votes were held. The future planning of cancer-therapy services in the Province was studied by a special task committee appointed by the Medical Advisory Committee to the Service. This followed from discussions in 1969 between Planning Group and the Hospitals' Committee of the British Columbia Medical Association. A revised system was set up for reviewing the hospital's functional programmes, which form the basis for the design of new hospital construction. The Task Sub-committee which developed the publication Hospitals for Extended Care, a Programme and Design Guide in 1969 was reappointed in 1970 to restudy the guidelines to ensure construction at the lowest reasonable cost and also to review the comments which have come in on the original guide from persons and groups, both inside and outside the Province. Studies of day-care services and of diagnostic and treatment centres were carried further. Day-care benefits under the Hospital Insurance Service were expanded as described elsewhere in this Report. 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 1970 by the various divisions and offices which comprise the administrative structure of this branch. P 22 BRITISH COLUMBIA ASSISTANT DEPUTY MINISTER W. J. Lyle, F.C.I.S. The Assistant Deputy Minister is responsible for the operation of the Hospital Finance Division, 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 19), Vice-Chairman of the BCHIS Planning Group (see page 21), 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-commit- *' :M tee on Finance, the Radiological Advisory Council, and the British Columbia Hospitals' Association Liaison Committee. During 1970 the Assistant Deputy Minister was appointed by the Department of National Health and Welfare as liaison officer for British Columbia to work with the national steering committee on health-care costs. A summary of the activities of the divisions for which the Assistant Deputy Minister is responsible follows. Hospital Finance Division N. S. WaUace, 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. At the 1967 Session of the Legislature, two Acts were passed which changed the method of financing hospital capital projects—the Regional Hospital Districts Act and the British Columbia Regional Hospital Districts Financing A uthority A ct. 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 1970, the Finance Division assisted the regional hospital districts in debenture sales to the British Columbia Regional Hospital Districts Financing Authority amounting to $18,500,000, and recommended capital grants of approximately $2,700,000 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 1970, after a review of approximately 5,500 applications received from hospitals, grants estimated at $2,100,000 were approved on movable and fixed technical equipment costing $6,500,000. As a means of assisting hospital employees to maintain high working standards, the Hospital Insurance Service provided over $135,000 during the year to enable hospital employees to attend or participate in short-term training programmes. This HOSPITAL INSURANCE SERVICE, 1970 P 23 was additional to the long-term educational training courses sponsored for certain hospital employees through Federal assistance. Close liaison was continued with the Commissioner of Municipal Superannuation in respect to the application of the Act to hospital personnel, and the postponement of retirement for certain employees who reach maximum retirement age. The Division Manager continued to perform duties as a member and Secretary of the Hospital Rate Board and as a member of the Sub-committee on Hospital Finance and Accounting (a subcommittee 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 five main functions of the Hospital Accounting Section are as follows: (a) The assembling of relevant information and preparation of data for the use of the Hospital Rate Board in its review of hospitals' annual and pre- construction estimates. During this process estimated revenues and expenditures are examined in detail, and adjustments to estimated amounts are recommended. The gross expenditure approved by the Hospital Rate Board for public general, rehabilitation, and extended-care hospitals for the year 1970 amounted to $183,000,000. (b) The detailed annual inspecting of each budget-review hospital for purposes of verification of annual and other financial statements. Final settlement with each hospital for that year is based on inspection and review results. (c) The assembling of relevant information and preparation of data for the Deputy Minister in the review of the annual budgets of regional hospital districts. (d) The auditing of hospital construction projects, in the field, to determine the amount shareable by the Province and the regional hospital district. P 24 BRITISH COLUMBIA (e) The tabulating of monthly statistical and financial reports from hospitals, correlating these with approved budgets, and the calculation of semimonthly cash advances to be made to hospitals. Other functions performed by the Hospital Accounting Section include: (a) The review and amendment of annual financial and statistical reports prepared by hospitals for submission to the Dominion Bureau of Statistics and the Department of National Health and Welfare. (b) The preparation of monthly and annual claims on the Federal Government under the Hospital Insurance and Diagnostic Services Act. (c) The tabulation of temporary borrowing for construction projects by regional hospital districts, and the calculation of the Provincial share to be paid to the district. The preparation and issue of debentures to replace short-term borrowing and the calculating of the Provincial share of repayment. (d) The provision of accounting and financial assistance and instruction to public hospitals in the Province. (e) The review of annual operating results and recommendation of year-end adjustments to the hospitals' approved budgets. (/) The preparation of the Annual Report on Hospital Statistics covering the administration of the Hospital Act. One hundred and fifty-five hospital-operating, pre-construction, and regional hospital district budgets were reviewed and processed in 1970. Inspection visits were made to each of 102 public general, rehabilitation, and extended-care hospitals during the year. Construction projects involving approved expenditures of $6,802,- 400 were audited, and cost reports involving approved expenditures of $1,338,950 for minor construction projects were prepared for regional hospital districts. 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 this 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, Lower Mainland, and Northern areas. The filing, accounting, and review of the quarterly billings for extended-care hospital patients continued to increase in volume as new units were added to hospitals or new hospitals were 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 1,800 per working-day for in-patients and over 850 emergency-service and 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 IBM 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 HOSPITAL INSURANCE SERVICE, 1970 P 25 500 claims had to be returned each month to hospitals because they were incomplete or unacceptable. Advice and assistance were given to hospital admitting staffs on the proper method of obtaining and recording the patient's residence information and employment history. In order to further assist in the co-operation between the British Columbia Hospital Insurance Service and hospitals, the supervisor of Adnrssion Control visited hospitals for discussions of the procedures being used for verification of the residence of patients. A regional meeting held at Terrace was attended by representatives from hospitals in the northern part of the Province. Regional meetings were also held at Comox and Victoria and attended by representatives of Vancouver Island hospitals. The supervisor of Admission Control attended a seminar held by the British Columbia Hospital Association in Vancouver. 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 the British Columbia Hospital Insurance Service, Workmen's Compensation Board, the Department of Veterans Affairs, or other provinces and territories. During the year over 6,000 queries on such accounting matters were addressed to the British Columbia hospitals. Preliminary figures for 1970 show that more than 425,000 accounts (excluding out-of-Province) were processed. For comparison, the figures for 1969 were 415,- 844 processed. The Day-care Surgical Services, Day-care/Night-care Psychiatric Services, and Out-patient Psychiatric accounts increased in volume from over 1,900 per month in 1969 to over 3,100 per month at the year-end. Several new hospitals were authorized to make Day-care/Night-care and Out-patient Psychiatric Services available as an insured benefit. The Voucher and Key-punch staff are responsible for batching and vouchering the checked accounts, in order to determine the amounts payable to each hospital and for punching of the IBM cards 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. This procedure includes punching cards for out-of-Province accounts and Day-care Surgical Services accounts. This section is also compiling statistics for a linkage study of congenital anomalies being carried on by the Atomic Energy of Canada Limited. The study will involve the punching of over 140,000 statistical IBM cards, of which 90,000 cards were punched at the year-end. The Hospital Claims Section sends statements to patients advising them of the amount paid to hospitals on their behalf through the British Columbia Hospital Insurance Service. During the year, over 325,000 statements were prepared and mailed. The Out-of-Province personnel process all claims for hospital accounts incurred by British Columbia residents in hospitals outside of the Province. This requires establishing eligibility and the payment of claim. During 1970, over 5,400 accounts, amounting to an estimated $1,900,000, were paid on behalf of qualified residents who were hospitalized in other provinces and territories of Canada and the continental United States, including Alaska and Hawaii; Australia, Austria, Belgium, Bermuda, Denmark, England, Finland, France, Germany, Greece, Guam, Holland, Hong Kong, India, Iran, Ireland, Israel, Italy, Japan, Java, Kenya, Malaysia, Mexico, P 26 BRITISH COLUMBIA Nepal, New Zealand, Norway, Philippines, Portugal, Puerto Rico, Republic of Ch'na, Republic of Panama, Saint Lucia, South Africa, Spain, Sweden, Switzerland, Taiwan, Trinidad, and Yugoslavia. Correspondence to accomplish the procedures amounted to over 19,000 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 IBM card punched for each account. The Filing and Mail Unit sorted and filed over 8,000 documents and letters daily, an increase of 1,500 over last year. The filing system was expanded and new procedures instituted, in order to accommodate the increase. Hospital Construction and Planning Division John Glenwright, Manager The main functions of this Division can be briefly described as follows: 1. The Division provides hospital boards of management, their architects and planning committees, with a consultative service in the planning of hospital construction projects, including new hospital facilities as well as additions and renovations to existing hospitals. Special emphasis is given to the need for the development of written functional programmes for construction projects related to the proposed new or expanded facilities. During the year a great deal of time was spent in reviewing programmes and plans of proposed hospital projects, both at the sketch-plan stage and the working-drawing stage. Drawings and architectural programmes which evolved from the hospital's functional programme were reviewed with the various professions represented in the Consultation and Medical Consultation Divisions, as well as in allied organizations, including the Radiology Advisory Council and the Laboratory Advisory Council. Reviews are made with several objectives in mind, but basically the intent is to ensure that, in terms of the capital funds available, the greatest benefit consistent with economical operation is derived from the construction projects. In planning hospital facilities, attention is also given to the need and method of future expansion in conjunction with the logical and best use of the hospital site. Proposed hospital sites are approved by this Division, and direction and guidance are given in site selection. Wherever possible, potential sites are inspected by a member of the Division. During the year, approximately 250 sets of plans were received by the Division. These drawings covered many phases of planning, including small-scale schematic drawings, preliminary sketch drawings, large-scale detailed drawings, and final working drawings and specifications, including the architectural, mechanical, electrical, and plumbing drawings. 2. The division is responsible for processing, and recommending for approval, applications for Provincial grant assistance, either by direct grants-in-aid or by funds provided through regional hospital districts, for major expansion and improvement projects as well as minor renovations for all public hospitals throughout the Province. Continuing benefit was derived during 1970 from the co-operation of the Department of Public Works in the assignment of architects to this Division. HOSPITAL INSURANCE SERVICE, 1970 P 27 In March, John Glenwright returned to his former position as Manager of the Hospital Construction and Planning Division following Wi years as Administrator of the Matsqui-Sumas-Abbotsford General Hospital. The Manager of the Division is a member of the BCHIS Planning Group, which has the responsibility of reviewing and making recommendations to the Deputy Minister on matters concerning the development of hospital facilities throughout the Province. He is also Chairman of the Functional Programme Review Committee and a member of the Equipment Committee, which are subcommittees of Planning Group. Mr. J. M. Phillips, Senior Architect of the Division, continued during the year as a member of the Hospital Cost Analysis Group. Through the co-operation of Health Branch personnel, and members of the medical and nursing profession, hospital boards were provided with a full consultative planning service. The Provincial Health Branch provided assistance through the Technical Supervisor of Clinical Laboratory Services and the Technical Supervisor of Radiology. Through the co-operation of the Provincial Department of Labour, the Office of the Inspector of Factories provided a consultative service to this Division, related to proposals for elevators and dumb-waiter installations in hospitals. The Manager of the Division acted as a member of the committee established to review and recommend revisions to the publication Hospitals for Extended Care, a Programme and Design Guide. In the interests of applying effective cost-control measures for capital-expenditure projects, policy was established requiring that independent quantity surveyors be retained by hospitals on all major construction projects. The Manager and members of the Division participated in the production of the booklet Cost Control in Hosptial Design, Using Quantity Surveyors, which is designed to clarify the role of the quantity surveyor. The booklet includes an outline of the function of a quantity surveyor as well as recommended procedures for preparing estimates and a draft of a suggested form of agreement between the hospital and the quantity surveyor. During the year, liaison was maintained with the mechanical engineering profession in recognition of the need to design high-quality mechanical systems which 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, reflecting this approach, included air recirculation and zoned heating and ventilating controls. Consultative advice is provided in the field of plant operation and maintenance and equipment selection. During 1970, 24 visits were made for inspection and advice pertaining to hospital mechanical plants and electrical installations. A simplified system of preventive maintenance, i.e., the Comae System, has been introduced and is either in use or is being incorporated in 16 hospitals throughout the Province. 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. During 1970, the architects and engineers made a number of inspectional, advisory, and educational visits to hospitals throughout the Province. In addition, the Manager visited convalescent hospitals in California to make comparisons between these facilities and extended-care units in British Columbia. P 28 BRITISH COLUMBIA (fl) Hospital Projects Completed During 1970 Chilliwack General Hospital, Chilliwack—Phase I of expansion programme: Moving nurses' residence and altering building for alternate use. Creston Valley Hospital, Creston—On May 4, 1970 the Honourable W. D. Black officially opened the expanded Creston hospital. This project involved the construction of a wing, bringing the total capacity up to 52 beds; of these, 44 are being used. The addition included new emergency and administrative departments, new operating-rooms, and boiler-room; also, extensive renovations were carried out in the existing hospital. Houston Diagnostic and Treatment Centre—The construction of this new facility was completed late in the year and it is now expected to be officially opened and brought into service in the new year. Royal Inland Hospital, Kamloops—Thirty additional acute and 10 additional psychiatric beds were brought into service on May 1, 1970, as a result of renovations to this hospital. Kelowna General Hospital, Kelowna—The new acute addition to the Kelowna General Hospital was officially opened by the Honourable Ralph R. Loffmark, Minister of Health Services and Hospital Insurance, on February 28, 1970. This new building, known as Block B, contains 175 acute beds and most of the diagnostic and treatment services for the hospital complex. The 71-bed extended-care unit was also completed this year and the first patients were admitted on December 2, 1970. Nicola Valley General Hospital, Merritt—A four-bed ward was completed at this hospital and brought into service on January 1, 1970, making the revised capacity of this hospital 41 acute beds. Langley Memorial Hospital, Murrayville—All unfinished areas in this hospital have now been completed, and by moving the 10 activation beds out of the extended- care unit, 10 additional extended-care beds have been gained. The revised capacity of this hospital is now 107 acute and 50 extended-care beds. Powell River General Hospital—The last four beds left unfinished in the extended-care unit were completed and brought into service on January 2, 1970. The revised capacity of this unit is now 34 extended-care beds. Princeton General Hospital—The Honourable Ralph R. Loffmark officially opened the new 25-bed acute hospital at Princeton on May 9, 1970. However, due to the construction strike during the summer which delayed the final completion of the building, patients were not admitted or transferred until October 17. Queen Victoria Hospital, Revelstoke—The construction strike also delayed by several months the completion of the new hospital at Revelstoke, which was officially opened by the Hon. Ralph R. Loffmark on December 19, 1970. The new building, which has 50 acute beds and 10 more beds which can quickly be brought into use when required, replaces the old hospital, part of which dated back to 1901. Mater Misericordia; Hospital, Rossland—Renovations. Surrey Memorial Hospital—A 78-bed extended-care unit was completed and placed in operation during May 1970. Trail Regional Hospital—Two projects were constructed concurrently at this hospital—a 50-bed extended-care unit and an addition to provide 24 psychiatric beds on one floor and a regional laboratory above. Both projects were opened officially on January 31, 1970. Royal Jubilee Hospital, Victoria—New laboratory facilities were officially opened at this hospital on January 16, 1970, as a result of adding another floor onto the South Wing. Adjacent areas were also renovated as part of the project. HOSPITAL INSURANCE SERVICE, 1970 P 29 (b) Hospital Projects Under Construction at Year-end Burns Lake and District Hospital—Construction of additions and alterations to provide an additional 17 acute beds and six extended-care beds. Chetwynd and District Hospital—A new facility of 30 acute beds to serve the Chetwynd and Hudson's Hope area. Chilliwack General Hospital—Phase II of the expansion project is currently under way involving an addition for 75 extended-care, 20 psychiatric, and 16 activation beds; new laboratory, physical medicine and dietary departments, laundry; plus the renovation of part of the existing hospital. Fort St. James Hospital—A new facility of 25 acute beds. Golden and District General Hospital—Additions and alterations to provide eight more acute beds (plus two unfinished) and six extended-care beds. Victorian Hospital, Kaslo—A new hospital of 10 beds is being built to replace the existing Kaslo hospital. Mackenzie and District Hospital—Construction of a prefabricated unit of 18 beds. Nanaimo Regional General Hospital—Construction of a two-story addition to provide 24 psychiatric and 25 activation/rehabilitation beds and an 84-bed extended-care unit, as well as renovations, etc. Royal Columbian Hospital, New Westminster—The construction of modular units to provide 174 acute beds temporarily to allow the demolition of the 1912 Wing preparatory to the construction of permanent additions to the hospital; plus renovation of existing areas. Lions Gate Hospital, North Vancouver—A 169-bed extended-care unit is being constructed adjacent to the acute hospital. Ocean Falls General Hospital—Renovations to an existing building, Kimsquit Lodge, are being carried out to convert the building to a 12-bed hospital. Penticton Hospital—An extensive expansion programme at this hospital involves the construction of additions to provide a further 38 acute beds, 63 extended- care beds, a floor in "shell" form, enlarged diagnostic and treatment facilities, and renovations to the existing building. West Coast General Hospital, Port Alberni—Due to the strike, construction has been delayed and work on the additions and renovations is still under way to provide a net gain of 28 additional acute beds, a 30-bed extended-care unit, and renovation of the existing building. Prince Rupert General Hospital—New hospital of 128 acute beds and 18 extended-care beds to replace the existing building. Richmond General Hospital—Construction of a 75-bed extended-care unit adjacent to the acute hospital. Shuswap Lake General Hospital, Salmon Arm—Additions and alterations to provide 12 more acute beds, plus 25 extended-care beds. St. Mary's Hospital, Sechelt—Expansion of the hospital to 45 acute beds. Surrey Memorial Hospital—One hundred and eighty-six acute beds and supporting services which form part of the major expansion programme under way since 1968 were declared "open" by the Honourable Ralph R. Loffmark on December 13, 1970. Patients were transferred a few days later to the new wings so that the renovation of the older parts of the hospital could be started. Vancouver General Hospital—Tenders were received and it is anticipated that construction of the 201-bed extended-care unit will commence. St. John Hospital, Vanderhoof—New 45-bed acute hospital to replace existing building. P 30 BRITISH COLUMBIA In addition, at the year-end, the following projects were out to tender: Lady Minto Hospital, Ashcroft—New 41-bed acute hospital. G. F. Strong Rehabilitation Centre, Vancouver—Expansion of hospital and facilities to 100 beds, plus "shell" floor. Gorge Road Hospital, Victoria—Addition to provide 300 extended-care beds. (c) Projects in Advanced Stages of Planning Burnaby General Hospital—Extended-care unit. Chilliwack General Hospital—Renovations. Lady Minto Gulf Islands Hospital, Ganges—Extended-care unit. Fraser Canyon Hospital, Hope—Expansion. Kelowna General Hospital—Renovation of previous main hospital building. Royal Columbian Hospital, New Westminster—New power plant. St. Martin's Hospital, Oliver—Replacement. Prince George Regional Hospital—Expansion and extended-care unit. Vancouver General Hospital—Willow Pavilion renovations. (d) Additional Projects Approved and in Various Planning Stages in 1970 R. W. Large Memorial Hospital, Bella Bella—Replacement. Burnaby General Hospital—Expansion of acute beds and services. Campbell River and District General Hospital—Expansion. Clearwater—Diagnostic and treatment centre. St. Joseph's General Hospital, Comox—Expansion. Cranbrook and District Hospital—Expansion of extended-care unit. Cowichan District Hospital, Duncan—Extended-care unit. Fernie Memorial Hospital—New hospital to serve Fernie and Michel areas. Gold River—Diagnostic and treatment centre. Boundary Hospital, Grand Forks—Extended-care unit. Wrinch Memorial Hospital, Hazelton—Replacement of acute hospital, plus seven extended-care beds. Windermere District Hospital, Invermere—Expansion. Royal Inland Hospital, Kamloops—Expansion, including extended-care unit, psychiatric and activation/rehabilitation beds. Kimberley and District Hospital—Renovations to complete five additional acute beds, air-conditioning, etc. Ladysmith and District General Hospital—Expansion (six beds). Lillooet District Hospital—Expansion of acute beds, plus extended-care unit. Maple Ridge Hospital—Expansion of acute hospital and extended-care unit. Mount Waddington Regional Hospital District—Approval given to acquire a site and plan a central regional hospital facility, construct ambulatory care and diagnostic facilities at Rumble Beach and Port Hardy, and renovate St. George's Hospital, Alert Bay. Langley Memorial Hospital, Murrayville—Expansion. Arrow Lakes Hospital, Nakusp—Replacement to serve Nakusp and New Denver. Kootenay Lake General Hospital, Nelson—Expansion of services and bed reallocation. Royal Columbian Hospital, New Westminster—Acute expansion and extended- care unit. Lions Gate Hospital, North Vancouver-—Expansion of services. One Hundred Mile District General Hospital, One Hundred Mile House— Expansion. HOSPITAL INSURANCE SERVICE, 1970 P 31 Pouce Coupe Community Hospital—Conversion of acute beds to extended care. G. R. Baker Memorial Hospital, Quesnel—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—Renovations. Stewart General Hospital—Expansion. Tahsis—New hospital to replace Esperanza General Hospital. Children's Hospital, Vancouver—Replacement. Holy Family Hospital, Vancouver—Expansion and extended-care unit. Mount St. Joseph's Hospital, Vancouver—Expansion and extended-care unit. St. Paul's Hospital, Vancouver—Services expansion. St. Vincent's Hospital, Vancouver—Expansion of services, psychiatric beds, extended-care unit, etc. Vancouver General Hospital—Activation/rehabilitation unit. Health Science Centre, Vancouver—Acute hospital (Phase III). Mount St. Mary Hospital (St. Joseph's), Victoria—Extended-care beds. Priory Hospital, Victoria—Extended-care unit. Royal Jubilee Hospital, Victoria—Renovations. St. Joseph's Hospital, Victoria—Renovations. Cariboo Memorial Hospital, Williams Lake—Expansion. L Major Hospital Projects, 1970 Completed—Creston, Kamloops, Kelowna, Princeton, Revelstoke, Surrey, Trail, Victoria (Royal Jubilee). Under Construction—Burns Lake, Chetwynd, Chilliwack, Fort St. James, Golden, Kaslo, Mackenzie, Nanaimo, New Westminster (Royal Columbian), North Vancouver (Lions Gate), Ocean Falls, Penticton, Port Alberni, Prince Rupert, Richmond, Salmon Arm, Sechelt, Surrey, Vanderhoof. For details, see pages 28, 29, and 30. Architect's perspective of the new Prince Rupert Hospital now under way. (Architects: Thompson, Berwick, Pratt and Partners.) The new Extended-care Unit at Surrey Memorial Hospital. (Architects: Underwood, McKinley, Cameron, Wilson, Smith and Associates.) The new Psychiatric Unit and Regional Laboratory addition at Trail Regional Hospital. (Architects: Paul Smith Associates.) The recently completed Extended-care Unit at Kelowna General Hospital. (Architects: McCarter, Nairne and Partners.) P 34 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 BCHIS 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 21 and 19 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. The Director participated in a research project, under Federal Public Health Research Grant 609-7-197, on a system of patient classification according to need for nursing care. The study was conducted through the Vancouver General Hospital and involved five British Columbia hospitals. The Hospital Administrators' Association and the British Columbia Hospitals' Association instigated discussion and reviews of the National Task Force Reports on the Cost of Health Services in Canada. The Director, who was chairman of one of the task forces, was involved in these programmes. Reports of the activities undertaken by the two Divisions responsible to the Director follow. Hospital Consultation and Inspection Division P. M. 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 the Hospital Rate Board, the Planning Group, the Functional Programme Review Committee, and the Equipment Committee. Staff members also participate in the hospital-planning functions of the British Columbia Hospital Insurance Service, including the review of the operational implications of HOSPITAL INSURANCE SERVICE, 1970 P 35 construction projects, and the setting of standards. Programmes and plans for construction are analysed and assessed, in conjunction with the Medical Consultation and Hospital Construction and Planning Divisions. 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 1970, 278 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. During the course of 1970 the Management Engineering Unit has expanded its scope of activities in 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. Consulting services are now being provided in addition to in-depth studies. 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. Research Division Wm. E. Selwood, B.A., Acting Director The Research Division is responsible for compiling and maintaining statistical data relating to hospitalization and morbidity in British Columbia. The hospitals submit Admission/Separation Records for each in-patient and a similar record for each outpatient. These records 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 on hospital utilization at the request of hospitals and independent consultants. During 1970, over 80 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 has 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. During 1970, the Division took part in "team visits" to several regional hospital districts for the purpose of providing guidelines for hospital development on a regional basis. The team consisted of members from several divisions of this Service, and following each visit a report was prepared for the region, outlining the needs for each of the defined levels of hospital care. The regions visited were East Kootenay, Central Kootenay, and Comox-Strathcona. 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. This year the publications have been redesigned to P 36 BRITISH COLUMBIA conform to the change from the 7th revision of the International Classification of Diseases, Adapted, to the 8th revision. Statistics of Hospital Cases Discharged During 1969, completed during the year, included 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, by type of accident, and by nature of injury. Another bulletin prepared and issued by the Division was an Alphabetical Listing of Place-names in British Columbia, With Geographical Code. In addition, a number of statistical tables, entitled "Hospital Indicators," were circulated to all hospitals. The format and detail of several tables were modified in order to give a broad view of hospitalization on a regional scale. However, these indicators still allow the individual hospital to focus attention on its own performance, as well as making a comparison with hospitals of a similar size-group. An increasing number of special requests by community agencies, private organizations, and by Government are processed each year. Mr. D. S. Thomson, Director of the Research Division, is presently on educational leave, and will be returning in mid-1971. MEDICAL CONSULTATION DIVISION D. G. Adams, M.D., Medical Consultant This Division is responsible for medical consultation within the Service, between other Departments of Government, with hospitals at all levels of care, and with regional hospital districts. Additionally, the Division is responsible for the medical coding and assessing of all discharge records received from hospitals, and for the central screening and quarterly review of patients for eligibility under the extended- care programme. The Admission/Separation Record, which is completed for each patient admitted to a hospital either in British Columbia or outside 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. The assessment and review of individual patients' applications for extended- care coverage continued to provide an increasing work load. A quarterly review of HOSPITAL INSURANCE SERVICE, 1970 P 37 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 and physiotherapy, whose specialized knowledge has been of great value. New extended-care units were opened during the year, increasing the application review load, and at the same time placing increased demands for professional advice on the implementation of treatment programmes in these new units. Dr. D. M. N. Longridge, Assistant Medical Consultant, has major administrative supervisory responsibility for the Coding Section, 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 this data may be tabulated in preparation for statistical reviews. The Medical Consultants provided continuing and active liaison with all health agencies, through visits to hospitals, special disease groups, societies, regional hospital districts, and professional bodies. Liaison with the British Columbia Medical Association has become particularly important, and active participation on its Hospitals Committee and the Advisory Sub-committees on Chronic Renal Failure, Intensive Cardiac Care, Nuclear Medicine, and Cancer Therapy Services continued during the year. The encouragement of hospitals to achieve accreditation standards imposes certain pressures to conform to the requirements of accreditation, and when these pressures produce problems for the medical staff of the hospital, the Medical Consultant is able, with the assistance of the Hospital Consultation and Inspection Division, to render assistance. The Medical Consultants assist in the planning and implementation of new services in hospitals by representation on the Planning Group, the Equipment Committee, and the Functional Programme Review Committee at the Hospital Insurance Service. The Medical Consultant and the Assistant Medical Consultant participated in the postgraduate continuing medical education programmes sponsored through the 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 consultative 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. Emphasis is placed on the need P 38 BRITISH COLUMBIA 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 work load 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 1970 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. 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 consider- HOSPITAL INSURANCE SERVICE, 1970 P 39 able 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 hospitals and the sorting and distribution of mail. Stenographic services were provided to the Information Office, and to other Divisions when the work volume permitted. The Supervisor of this office is also the Safety Officer for the Branch. P 40 BRITISH COLUMBIA INFORMATION OFFICE C. N. Shave The Information Office is responsible for the continuing development of public information activities. Its three main areas of involvement are general hospitals, public, and in-service requirements. During the year, an effective public relations programme was carried out which involved hospitals, employees of the British Columbia Hospital Insurance Service, the press, and other branches of the Department. The BCHIS Bulletin, an administrative aid providing detailed explanation of policy and procedures, was changed in format to include interesting items and pictures from hospitals and our own staff. This change had several purposes, namely, to give hospitals a better understanding of the British Columbia Hospital Insurance Service and its problems, to make the Bulletin more interesting, and to improve morale. Published every two months, with a circulation of 1,800, it is sent to public and private hospitals as well as interested members of the general public. A departmental contest was held in May to find a suitable BCHIS symbol. There were over 50 entries, from which the four judges (representing the Department staff) selected the winning entry which appears on the cover of this Report. The use of symbols for identification of government and industry is increasing, so it was felt that if the Service was to carry out an effective public relations programme, an identifying symbol should be included as a basic element of that programme. Recently, name tags bearing the symbol were purchased for our consultants for ready identification in hospitals. And, besides appearing on our publications, it will progressively be incorporated on stationery, pins, vehicles, and crests. Emphasis has been placed on developing a close working relationship with members of the press and press gallery, and, during the year, health reporters from the local press were invited to visit with our senior officials for a "behind the scenes" look, in order to give them a better understanding of the problems British Columbia Hospital Insurance Service has to cope with. The result has been greater co-operation on the part of both. Excellent active co-operation was established with the Health Branch Audio- Visual Section and Stockroom, which resulted in much of our photographic, art work, and printing being done at considerable saving. BCHIS films were also transferred to the Health Branch Film Library during the year, where they are now being cared for with the latest film-cleaning facilities, and distributed to hospitals as part of their own film stock. This has resulted in greater efficiency. Visits were made to the Pacific National Exhibition, Vancouver, in July for a complete updating of the BCHIS display. Later, in September, our display for the British Columbia Hospitals' Association Convention was redesigned, set up, and manned at the convention, which was held in October at the Bay shore Inn, Vancouver. In addition, a small pamphlet was printed to coincide, which gave the latest hospital statistics on construction and costs of benefits. Hotel accommodation and transportation facilities were also arranged for the saff. Numerous telephone and mail inquiries were received regarding hospital insurance benefits, many from new residents of the Province. In addition, there were 700 Annual Reports and over 36,000 pamphlets sent out to hospitals and the general public on the British Columbia Hospital Insurance Service and its benefits. Several manuals and serial letters were also sent out. Numerous press releases were issued during the year to keep the public informed on hospital construction programmes, policy changes, and other items of HOSPITAL INSURANCE SERVICE, 1970 P 41 public interest. Several articles were also written, as well as newspaper fillers, and a history of the British Columbia Hospital Insurance Service has been started. Other duties included summarizing annual reports from hospitals for the information of the Minister and Deputy Minister, maintaining a photograph file and a newspaper clipping service, replying to general correspondence, and the preparation and editing of this 22nd Annual Report. 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 Hos- pi:al, 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, Murray ville. Lillooet District Hospital, Lillooet. Lions Gate Hospital, North Vancouver. McBride and District Hospital, McBride. Maple Ridge Hospital, Maple Ridge. Mater Misericordia. Hospital, Rossland. Matsqui, Sumas, and Abbotsford General Hospital, Abbotsford. Michel-Natal District Hospital, Michel. Mills Memorial Hospital, Terrace. Mission Memorial Hospital, Mission City. *Mount St. loseph 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 Regional 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, 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, Salmon Arm. Slocan Community Hospital, New Denver. Squamish General Hospital, Squamish. P 42 BRITISH COLUMBIA Stewart General Hospital, Stewart. Summerland General Hospital, Summer- land. *Surrey Memorial Hospital, North Surrey. Tofino General Hospital, Tofino. *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. Outpost Hospitals Red Cross Outpost Nursing Station, Alexis Creek. Red Cross Outpost Nursing Station, Atlin. Red Cross Outpost Nursing Station, Bamfield. Red Cross Outpost Nursing Station, Blue River. Red Cross Outpost Nursing Station, Edge- wood. Red Cross Outpost Nursing Station, Kyu- quot. Red Cross Outpost Nursing Station, Masset. Federal Hospitals Veterans' Hospital, Victoria. Shaughnessy Hospital, Vancouver. *Miller Bay Indian Hospital, Prince Rupert. RCAF Station Hospital, Holberg. Licensed Private Hospitals Industrial Hospitals in Remote Areas With Which the Province Has Entered Into an Agreement Requiring Them to Furnish the General Hospital Services Provided Under the Hospital Insurance Act. Bralorne Private Hospital, Bralorne. Cassiar Asbestos Corporation Private Hospital, Cassiar. Mica Creek Private Hospital, Mica Creek. Port Alice Private Hospital, Port Alice. Rehabilitation Hospitals Van- *Shaughnessy Hospital, Vancouver. *Sunny Hill Hospital for Children, Vancouver. *Veterans' Hospital, Victoria. (A number of the larger public hospitals also have rehabilitation units.) G. F. Strong Rehabilitation Centre, couver. The Gorge Road Hospital, Victoria. Holy Family Hospital, Vancouver. Pearson Hospital (Poliomyelitis Pavilion), Vancouver. Queen Alexandra Solarium for Crippled Children, Victoria. Other Hollywood Hospital Ltd., New Westminster (licensed under the Mental Health Act). Extended-care Hospitals The Louis Brier Hospital, Vancouver. Menno Hospital, Abbotsford. Mount St. Francis Hospital, Nelson. Mount St. Mary Hospital, Victoria eluding top floor). (ex- * Hospitals with extended-care units. Pearson Hospital, Vancouver (excluding facilities for tuberculosis patients). Priory Hospital, Colwood (24-bed unit and 71-bed unit). HOSPITAL INSURANCE SERVICE, 1970 P 43 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. P 44 BRITISH COLUMBIA In 1970 there were 91 public general hospitals approved to accept British Columbia Hospital Insurance Service patients. Care was also provided in seven outpost hospitals, four Federal hospitals, five contract hospitals, five public rehabilitation hospitals, and one rehabilitation hospital operated by the Provincial Government. Hospital insurance coverage for patients in nonprofit extended-care hospitals and units commenced December 1, 1965. At the end of 1970 there were 27 hospitals providing extended care. Data for the year 1970 have been estimated from reports submitted by hospitals to October 31, and are subject to minor revision when actual figures for the year are submitted. Table Ia shows a total of 354,700 British Columbia Hospital Insurance Service adult and children patients were separated (discharged) from British Columbia hospitals in 1970, an increase of 15,291 or 4.4 per cent over 1969. 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 95.7 in 1968 and 95.6 in 1969. Table 1b indicates that in 1970 the British Columbia Hospital Insurance Service paid public hospitals in British Columbia for 3,233,100 days of care for adults and children, an increase of 76,929 days or 2.4 per cent over 1969. As shown in Table 2a, the average length of stay of British Columbia adult and child patients in public hospitals during 1970 was 9.12 days, and the days of care per thousand population were 1,736. For comparison purposes, the data for extended-care hospitals is not included in the above observations, but it should be noted that an additional 260 days of care per thousand population were provided for these patients. Table 2b, under "Minor Surgery Patients," includes an estimated 30,000 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. HOSPITAL INSURANCE SERVICE, 1970 P 45 Table 1a—Patients Separated and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public General Hospitals1 Only (Excluding Federal, Private, Extended-care, and Out-of-Province Hospitalization). Total Hospitalized Hospitals in Public Covered by BCHIS Adults and Children Newborn Total Adults and Children Newborn Total Patients separated— 1Q40 164,964 216,743 261,128 271,609 277,073 285,998 292,119 301,510 314,585 326,793 338,923 354,766 370,600 26,272 33,190 39,599 38,226 37,697 37,231 35,688 33,555 32,488 32,014 33,529 36,550 38,000 191,236 249,933 300,727 309,835 314,770 323,229 327,807 335,065 347,073 358,807 372,452 391,316 408,600 140,168 199,774 249,654 259,953 264,655 272,597 278,023 286,799 299,518 311,718 324,769 339,409 354,700 84.9 92.2 95.6 95.7 95.5 95.3 95.2 95.1 95.2 95.4 95.8 95.7 95.7 24,640 31,515 38,980 37,558 36,505 35,878 34,196 31,863 30,814 30,377 31,635 34,576 36,000 93.8 95.0 98.4 98.3 96.8 96.4 95.8 95.0 94.8 94.9 94.4 94.6 94.7 164,808 1955 231,289 1060 288,634 1961 297,511 1067 301,160 1963 - .- 308,475 1964 -- -- 1965 1966 1967 312,219 318,662 330,332 342,095 1968 356,404 19692. 1970S. Percentage of total, patients separated— 1040 373,985 390,700 86.2 10.5 92.5 1060 96.0 1061 96.0 1067. 95.7 1063 95.4 1064 95.2 1965 95.0 1966 95.2 1967.. 95.3 1968.. -_ 95.7 19692 ' 95 6 19703 95 6 1 1 Includes rehabilitation hospitals. 2 Amended as per final reports received from hospitals. 3 Estimated, based on hospital reports to October 31, 1970. P 46 BRITISH COLUMBIA Table 1b—Total Patient-days and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public General Hospitals1 Only (Excluding Federal, Private, Extended-care, and Out-of-Province Hospitalization) . Total Hospitalized in Public Hospitals Covered by BCHIS Adults and Children Newborn Total Adults and Children New- T . , horn lom 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 3,315,760 3,386,500 213,874 227,674 249,273 240,207 274,032 270,298 260,979 245,756 235,796 239,972 244,715 248,324 253,800 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 3,564,084 3,640,300 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 3,156.171 3,233,100 85.0 91.2 95.0 95.2 95.0 94.7 94.7 94.0 95.1 95.2 95.3 95.2 95.5 1 I 200,585 | 1,631,231 1955 212.514 1 2.217.679 I960 241,157 231,043 263,475 257,736 246,813 230,096 220,270 222,543 226.633 2,692,996 1°61 2,777,387 1962 2,837,109 1%^ 2,889,407 1064 2,916,989 1965 - 1966 1967 - 1968 - 2,977,328 3,081,530 3,168,543 3.301.592 19692 231 803 I 3.387.974 19703 238,500 93.8 93.3 96.7 96.1 96.1 95.4 94.6 93.0 3,471,600 Percentage of total, patient-days— 1040 86.0 1955 91.4 1960 95.1 1061 95.3 1962 95.1 1Q63 94.8 1Q64 94.7 1965 _ 94.0 1966 93.4 I 95.0 1967 92.7 95.0 1968 -- 92.6 1 95.1 19692 ___ ... 93.3 | 95.1 19703 04 0 05 4 1 1 Includes rehabilitation hospitals. 2 Amended as per final reports received from hospitals. 3 Estimated, based on hospital reports to October 31, 1970. HOSPITAL INSURANCE SERVICE, 1970 P 47 Table 2a—Patients Separated, Total Patient-days, and Average Length of Stay According to Type and Location of Hospital for BCHIS 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... 1968 19691 19702 Patient-days— 1949 1955 1960 1961 1962 1963 1964 1965 1966 1967 _. 1968 19691 19702 Average days of stay— 1949 1955 1960 1961 1962 1963 1964 1965 1966 1967 1968. 19691 19702 149,280 209,999 264,120 273,293 278,021 286,753 293,144 301,522 314,391 325,861 338,706 353,457 368,270 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 3,397,005 3,467,575 10.03 10.00 10.03 10.09 10.03 9.94 9.91 9.90 9.89 9.79 9.77 9.61 9.42 24,989 32,035 39,488 37,968 36,942 36,326 34,652 32,240 31,152 30,804 32,031 34,974 36,385 203,197 215,980 244,480 233,794 266,351 260,771 | 249,827 | 232,438 | 222,475 | 225,479 | 229,053 234,098 241,065 8.13 6.74 6.19 6.16 7.21 7.18 7.21 7.21 7.14 7.32 7.15 6.69 6.62 140,168 199,774 249,654 259,953 264,655 272,597 278,023 286,799 299,518 311,718 324,769 339,409 354,700 1,430,646 2,005,165 2,451,839 2,546,344 2,573,634 2,631,671 2,670,176 2,747,232 j 2,861,260 I 2,946,000 I 3,074,959 | 3,156,171 I 3,233,100 | 24,640 31,515 38,980 37,558 36,505 35,878 34,196 31,863 30,814 30,377 31,635 34,576 36,000 200,585 212,514 241,157 231,043 263,475 257,736 246,813 230,096 220,270 222,543 226,633 231,803 238,500 10.21 10.04 9.82 9.80 9.72 9.65 9.60 9.57 9.55 9.45 O An 9.30 9.12 I 8.14 6.74 6.19 6.15 7.22 7.18 7.22 7.22 7.15 7.32 7.ift 6.70 6.62 7,093 8,313 11,557 10,361 10,226 10,895 11,605 11,417 11,459 9,436 9,310 8,867 8,120 45,960 75,599 169,401 182,690 183,042 187,714 199,164 205,488 212,413 195,564 188,152 186,565 178,475 6.48 9.09 14.66 17.63 17.90 17.23 17.16 18.00 18.53 20.72 20.21 21 01 21.98 151 361 241 151 157 169 149 114 101 83 80 94 85 1,146 2,271 1,417 878 850 1,018 878 619 541 451 434 463 415 7.59 6.29 5.88 5.81 5.41 6.02 5.89 5.43 5.36 5.43 5.42 4 92 4.88 2,019 1,912 2,909 2,979 3,140 3,261 3,516 3,306 3,414 4,707 4,627 5,181 5,450 21,515 19,622 28,889 27,631 32,679 31,174 36,204 32,372 37,028 47,648 46,422 54,269 56,000 10.66 10.26 9.93 9.27 10.41 9.56 10.30 9.79 [ 10.84 10.12 10.03 10.47 10.28 I 198 159 267 259 280 279 307 263 237 344 316 304 300 1,466 1,195 1,906 1,873 2,026 2,017 2,136 1,723 1,664 2,485 1,986 1,832 2,150 7.40 7.52 7.14 7.23 7.24 7.23 6.96 6.55 7.02 7.22 6.28 6.03 7.17 699 873 990 1,100 835 305,940 358,675 409,514 502,365 556,500 437.68 410.85 413.64 456.70 666.47 1 Amended as per final reports from hospitals. 2 Estimated, based on hospital reports to October 31, 1970. 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, 1,757; 1970, 1,736. (1954 and subsequent years are based on total population. Because the Armed Forces, Royal Canadian Mounted PoUce, 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 243 in 1969 and 260 in 1970. Population figures are revised according to latest census figures. P 48 BRITISH COLUMBIA Table 2b—Summary of the Number of BCHIS In-patients and Out-patients Total Adults, Children, and Newborn In-patients Estimated Number of Emergency, Minor-surgery, Day Care, and Out-patients Total Receiving Benefits 1949— 1955— I960... 1961— 1962... 1963... 1964 ... 1965— 1966... 1967... 1968... 1969L. 19702.. 174,269 242,034 303,608 311,261 314,963 323,079 327,7% 333,762 346,242 357,538 371,727 389,531 404,655 29,000 70,553 107,312 121,000 128,000 135,000 141,000 160,000 175,000 195,000 210,000 220,000 235,000 203,269 312,587 410,920 432,261 442,963 458,079 468,796 493,762 521,242 552,538 581,727 609,531 639,655 Totals. 6,267,649 2,534,073 8,801,722 1 Amended as per final reports received from hospitals. 2 Estimated, based on hospital reports to October 31, 1970. Table 3—Patients Separated, Total Days' Stay, and Average Length of Stay in British Columbia Public Hospitals for BCHIS Patients Only, Grouped Accordingly to Bed Capacity, Year 19701 (Excluding Extended-care Hospitals). Bed Capacity Total 250 and Over 100 to 249 50 to 99 25 to 49 Under 25 Patients separated— Adults and children Newborn Patient-days— Adults and children Newborn Average days of stay— Adults and children Newborn.— 354,700 36,000 3,233,100 238,500 9.12 6.62 175,000 16,600 1,701,300 114,100 9.72 6.87 86,400 9,700 718,100 62,700 8.31 6.46 51,700 6,400 507,000 41,500 9.80 6.48 34,200 2,700 251,500 16,600 7.35 6.15 7,400 600 55,200 3,600 7.46 6.00 i Estimated, based on hospital reports to October 31, 1970. Table 4—Percentage Distribution of Patients Separated and Patient- days for BCHIS Patients Only, in British Columbia Public Hospitals, Grouped According to Bed Capacity, Year 19701 (Excluding Extended-care Hospitals). Bed Capacity Total 250 and Over 100 to 249 50 to 99 25 to 49 Under 25 Patients separated— Adults and children Newborn Patient-days— Adults and children Per Cent 100.00 100.00 100.00 100.00 Per Cent 49.34 46.11 52.62 47.84 Per Cent 24.36 26.94 22.21 26.29 Per Cent 14.57 17.78 15.68 17.40 Per Cent 9.64 7.50 7.78 6.96 Per Cent 2.09 1.67 1.71 1.51 1 Estimated, based on hospital reports to October 31, 1970. HOSPITAL INSURANCE SERVICE, 1970 P 49 CHARTS The statistical data shown in the following charts prepared by the Research Division are derived from Admission/Separation forms submitted to the British Columbia Hospital Insurance Service. The major diagnostic categories used for the table on pages 55 to 60 are more detailed than the diagnostic groups shown on the charts. Both lists are based on the 8th Revision, International Classification of Diseases, Adapted, prepared by the Public Health Service of the United States Department of Health, Education, and Welfare. Readers interested in more detailed statistics of hospitalization in this Province may wish to refer to Statistics of Hospital Cases Discharged During 1969 and Statistics of Hospitalized Accident Cases, 1969, available from the Research Division. P 50 BRITISH COLUMBIA y^mm o z __- a° o 5 ,„ z "5 _i - o iC < o z z^ o U < S p. a c ^ •\ -*•( ''-.'-'"■".';1W.'.":7 s z 5 = 55 .•1 ^^M BV llB^l— rS n 1 < s wf^ W\ . \ •8 <u Ih SO •3 73 a HOSPITAL INSURANCE SERVICE, 1970 P 51 u a Q Z a $ E o o •o vo w-i *n vo vo >n *n ci n <S *-. _h Oi (N TH ,_ s ,H Q z < 2 p. ■< o < ~ f_ d es vo vo in >n IS <S TH TH P 52 BRITISH COLUMBIA y z _j U H < _E W tt, O o w >J X u HOSPITAL INSURANCE SERVICE, 1970 P 53 OS 3\ UJ -4 I & tt, 3 __ u < P 54 BRITISH COLUMBIA Chart V—Average Length of Stay of Cases* in Hospitals in British Columbia, by Major Diagnostic Groups in Descending Order, 1969 (Excluding Newborns). Certain cases of perinatal morbidity and mortality Diseases of the circulatory system Neoplasms Endocrine, nutritional, and metabolic diseases Diseases of the musculoskeletal system and connective tissue Congenital anomalies Mental disorders Accidents, poisonings, and violence Diseases of the digestive system Diseases of the skin and subcutaneous tissue PROVINCIAL AVERAGE LENGTH OF STAY Diseases of the blood and blood-forming organs Diseases of the nervous system and sense organs Infective and parasitic diseases Diseases of the genito-urinary system Diseases of the respiratory system Complications of pregnancy, childbirth, and the puerperium Symptoms and ill-defined conditions W///M///////A s W/////A. I I 1 7/ 13.8 W™M 12.2 10.3 10.0 WM 9.6 8.9 S. 8.5 7.0 6.8 5.8 m 5.5 m i * Including rehabilitative care. HOSPITAL INSURANCE SERVICE, 1970 P 55 Z Hi o ca a. Z o z Q P i-l U X W ON ON c/_ X 2 o - < U H t/i O z o < O z o H < -I < s o tn ■o\NO j p co in o^s) oo^^i>intnoo?-<ocsooeS(S(SOr>^N'-a>inrnTi-aoot--i--< Sooo ;ooo oo oooooo'ooo'o'oooooo'oooo'o'ooo'ooo rtJ3 >» \o o m y-i th ri 6 ih o d ,' O M »n 1 d © o o r-i d d ^HNnNN^Hq^«fn^r<qmMHqN(N(Nq-«)r. ^S<o'<Hid'^^<^ci'^<oSSt-iSc^^<6<^St-iciSScoS inOppo |(nvoo\ oo vo u^oq^r^o\ooi^r^^pr^pt^\ooor^MO\»n\OTro\i>r-;Osp od m vo oo vo ' ,_; cn o. 06 ri ^'r^ri^' r^mo\5«nr^Oi6ododc.N^oov_.^ro(Nt^od rH r-, (M i-i i-i >HHr.fNtv|rNr.HNTHT-i ,-h t_i .- <^ ,— r.nrlHH r--incvirHTtOvD'— m om vooov'-ivO'-'Ovvor^r-ovvorO'-'OrJiovTfooTj-oCTvMOO'-i ^ t mgo\ co ■* th sd m M'-'OvorJrJTrvDvo>nrivoTj-c<.<*it--*-(T-HooovvD»-.o\oo(N i£,-B$ ovcS'-'vO'-i i-ior^ wt* co t n t* x' ic r^* rn th in oo oo" in r-" «" n fi-T r* n irT oC «U r-CO rH,-. o t-h (N t-h ^h C4 <nvo«NTj-mooooo to m >n c. —< r- w. © *-'vOpfS'*c3v(N"n'^- osv.(SWOvVOaooawTtv.H N'tioN ^w^^inooNCT\r~>(St<.«otTvr*'Hr*f<.rl'NLvooi nxtHTt <N r) m o\ \D vO m t-h -j vo o\ m to nqmiH^ vi & htJ 0,10 «-) « th h h rf I 2 ,-h t-h ^ fS rtT H NMX3 Ov I -r— 00 °\ ^o^qq „ Ttinr.HOHTtorimmiri«ihH --' M r) vo r> CS © m <n vc vo r— _, r- co . oo oo co oo oo qi _. i - !~. t_ _ - r4 a p 4 33.. u ° "I as C.5 ■o E s 3 £ £ 2 o. tj SS.gao.3 ■9 S.5 S S o v, 8 rt a 5 s ■a»OH o " s .b 75 • if ill t- U .33 t3 3Z3 w<>£o * ci m ^ *n \o t~ od - tj g g ei rt '33 S o p « 3 2 S S t_ 33 i_ T- flj o o *o o sags a a a & oooo u u _ u o c a a a* & t- r" Ih £"§_£ <o O S3 > 6 a J3U30 ! 2 »h c h U T3 &_3 OOOOOOOOOOOO O 43 H 000 IflWIOlWWMtfiWIflWt.WlBKI'a a o. n ft ft peCkft & && & &'E. n 0O00OOO00O0O00>. OOCJOOOOOOOOOOO — c d fl c c c c rt cJ ri rt c3 cS rt §§ a S >o ■J-; 01.1 56 Cl; CIj S rt rt rt rt ddCddccdddcd^E 'ramTj-invor-ooOv Sc o o o o o g I S E E fl CO tfl Vi 7. c/i rt rt rt rt 5 aft o, ft ft o o o o C o o cj o u d d d c ^j co do bo ea J3 d "3 C "3 2 o to to <u OnncqpQ ■•ri rn^t in P 56 BRITISH COLUMBIA «j 3 •5 K O 1 to Z Bi o m a o z 3 p o X W OV Pi o 3 w H < U H O z o Pi o < z o H < N CO O w rt(J Q o o 60 rt J3 >> •h ti, rt d © ■>*t-htht-h inrHtOT-Hr^r-oiT-H'^-ooTfoor-co r-^co©vo*^voT-HT-^c^co<ncOT-HT-- r-i odd T*H©©d©©©d©TJd©©© TiSni&GcoGoStdi&t-iiotzici nqin odd eo t-h ^r-HH|^H(NqH^HHWMnTt'tN^^^^oo^HOT^Hmtnn^ll'f o© T-H©©©©©ddd©©©dco©d©©*-H,odd©co©©©©dd©©© voovoo T"H. t-- mqr>O\mm^DNc0vqNr-;qN(vl^;fn'jTH f~;wl<Sf*l*©lf.,~;f,l'^'. e>\>n^t,n •^ \d so t~ o\ ^r^f.'Hinf^m^itcrifir^«NTHcd\Dt^'Hinv.ri TH ,_| ^HHW-Hfg^. .-IT-H ,_ ,_, ,-H rH T-H T-H t-H t-h T-H CN CO CS T-H O O 00 cs oo moor* cs ro es oo c-^ on tj-^ t-h cs t-h" r-^ co" •>* rNr^oooooHr-[>.TfTtc>'HOOOcoooTHp.r^ij\'*^r.oo vomv.po\,*r-«c. T-HQvpesr-©cor-coco©vovovpoorf(SeS t-- Ov t> O co m oo eSOr-^Tl-Tj-coco ffiTiffi'jHifliotNii.'HO pT,f;^.,^,'!r1 ^ °. ^^ ^,K!,rirH„0i1 9,"^,^L(viH„Hp[Si_0i co"e>fes"esw^©covoco"vo"co~co"inco"r^T^T^e^co"rH es vo eo" es t-h m oC oo" © ti-" -4"" OO in th tS T-HVOT-HCStNT-Hin CS CS th t-h t-h t-T-iro CSfO o\T-Hrocor—00^-d-cjvt— ro©rf vpr^cS es m sOTtco<z?Ttsot~-tnTTe-sasasr4 NHh — co co c ' r- oo -rj- tj- ov t— co©rj-coco«TtopTf T-Hoo©"*voM<n ©vcvooocot-ionoo Tfvot^«n^oONOvcScs©as,d-fO(0©r»ooTfTj-roovco»-<©T-Hi-*,^,oo fin r- th 4 ij •* ih t^« ts't tn vo es^ »n cS r^ t-h es_ cs co es »h as ©_ vo m CO" rf THfO^T-HT-HT-TlnTHT-HTf rn, l-H IH TH < o 0 cs es <^ 22 es <s t-h *n oJ cs • es rs " ] i es cs ^vi i i-H cs co cs ■ CS Ov i CO I VC . m r- Tf ■•* «n .cocstscses ©cs . cs I I ■* | m I •> „o o cs co es t^- • es cs *H\ f. tj- w* V ^ ' vo r- C* oo oo t— escscses© — csco 1 I _L J. a © a 9 \o r- r- co es cs cs es t-oo oot-h „ ©T-Hooesco cscs ©—■escoi—invoT)"©fo-T}-cococococo© I | COM I lOVOvOVONOO© "I t 1^ ■<t©eseses©rses eSeseococoes©QQ©co r- co co o I ©T-HcscSco co oo on 'tn so cs m ""r co eo co m ■*£ *t *"* J I t- ©t-hcscSco -mvo eo co eo co eo co co co : _. E z 3 a I _. 8a A) t_ ■3 o 1? £ 2 O S3 & a a o a a a a, ISS a §11.1 Y a a a I -a -a | Smmo ■ __- j s •« il .2*3 .t: -° 3 O <vi « &_ ° C 00 a c a£ 0! 2 •a 85 a-o-g «q fl) 7. 89 .? _: rt J_ ° rt .O -a a ,2 •S S .S "SC. 2 ™ > - ° 3 2 . c_ M g g ,55 a) s 'C ■ 6 s 2 5 '.2 2 ES 8-aa- uo i 2 x .! i '3 2 "O S - 2 O u 9 ZHOOO<.UO g. o ■o ■o ■ S.2' hI 1 fl) T. ^ ills S3 «.«■§&■. :i?ll|isi i.o„<i_<oz E Si. H o.2 : 1*1 _ s M _c a « ft g g a O-O & rs * JE L_ TO «*■ <OOS! S a ^ Iii il 2"S 2 9 . b« « 3 rt o .83 3 S.S1 >. 4 0) ±_ M 1 rt a) ' 33 >» fl) fl) rt a o c«S 8 S rt ° s i o > a a ■= "i Sap, g« I i i WOPSm !■*■*■*' i ^3 r ■ M- ■ HOSPITAL INSURANCE SERVICE, 1970 P 57 voT-HrjvoT^rJT-HiesTf\qe»'—i^csT-H^TtM oddddoinddof.T.dd'-NooddrH'do'dwdMTH'H o* © © d o" © o\ © © o *A cs © o'o © o © © © *-5 © © **t ci ©*« •^•-Hcocs^'^pOTtovovesovin'-tcoescoeSTt T-HT-.-efdd©dd©d©dd©dd*-HT-H'dd vqeStncor-©'-HOv©vo>. " vd vd i> t-h d ov cs Tt •* *» co •*" t-h d es' vo' co Tt vd *h t> r^ »-. t-h cofSicscow©r^^^eOieo©^rJ©^'>t^c^vD-r|"vo©c>c>e/.©vot^w es r» ov co vo m oocoQcocoooocor~-o\cooesor-©invo_---in©oovoT-Hy-}Tt TjTtM(j,|-'HTHr.r*o>0'rtt,-cMs- vo in oo eo © vo t- vo so eS co in oo r-t Ov t-h oo^ r^ tn vo © in "* t> »2» in m h vo O't vp •* oo ** t. ^"),« tN h <n «h h * in"inc^co"r^^(Svo\oco"inTt**^"oCTr"oo oo'wi r-'eo m. m"d hhth^V co r- co *■* co co TtouoM-coejico esr»a\covom oocoococooooco vo u\ co cn^ ©^ vO r*^ vo^ no c\ co in oo^ r-t _. co eovoejvesvor-»neo"ov'co"voTt"»n'in ov co" r- rt r^v^\oco"inTtTt^"av"rt"ooco"r-^ TH t-H CS TH THOVnM COr-T-H<S T-H^^H VO VO tH (S| Tf ff) n ■rt cS t— t-h co m inoovoeoovrH T-HavO\©voONin© T-Hr^oovoeST-H(^[^ov>-HT-HTtvoONTteSino\©in rtovT-Hoovoco esvoovoTtmO'Tt r- —■ esinineST-Hi>ONC©o--<T--TtoveSininesco ft'tO Obts tn «bn ft vo >n N O^n Wror-' mHcvtrM e^ ^vd^thco^c^o^ r^ m ^ T-H CO T-HCS T-H*TtO\CS T-H CO" T-H CO'cS Co" Ov" CS T-T Tt CO" **- TH TH CO in T-H T-H fO(oesov©Ovcsr^TtinT—oves vomr-oocoooeSTtcortesrtes mvocoincot-movesminco ■^ in co t-h co ^t t— r- »oo _co co co es eo es co t-h C^l CO .. T rt rt Tt O *> 00 C\ VO rt Vp CS m t-h vo r- co ov r+lnTtrtrJ-'rq-cOOCOrt rt rt VO © © © w - m vp vo t- oo on rt rt rf rt rt rf m co vo m t— m on i *"• t-h t-h „ r- es es i ■n <n rt in m «n es i Tf Tf Tt CO ■■'< ■ ■ ■"-■■ '..'■, 'J iIonoo© - * -'-'Jll ©pprtmmtnts © m "^ Q © vo ) CO T-H CO . rt m <n . in m in © r © d rf in . rt m m . m in m P 58 BRITISH COLUMBIA rtU mpi^-^cm-moo^^^ ** c^-;^. cm .* <i P ■"* *£J -^ cidddd' ON »H \D C-> do--© s -5 s o O o CO fl — >_ cSeSespovmT-HeSoor^r-oo T^^fi^ini^Ttcortqini dT-Hdo'T-Hddd©T-.d© ©'--'©©"©'©©©©'t-h't-.co' es in rt co es i ddoHMi Ov i-h es vq oo d t-h! d «h © TtcOTtvqinooT-Hcoortininr^oortOvr^TtpininT-H(>< f* d oi *o r.eKmTtr^eoo\r*v6»inw\0(cjooviHtnvii co p © p r^ ov in in vd co* co* in Ov Ov Ov CO y co Ov od TH 2 o CQ w Sh o z S >-l u X W vocor--T-.ooNvo©coT-Ho©rt©rtineSrtinooeST-Htr-co vo r- t^ *-i © es ininvoescsr^eST-Hvococ»T-H\oovOesoNOovovot--cortr-- es co m vo >-< t-h inT-HiteSi>coTtoooomoocoovcoON©ONT-HT-iT-icst—coo Ov oo t—i m co t-h rtu -"t^-O^ND0-<00tt*« vOM^-(.M^*_«Ov^N^_t.^^C^^t^^*OQ . -*t o r~ oo -. . ^ c- 1-. e> _ cor.cluNO*o,03^-M_r.r^oo_r-^«a)' e}\ vo r^ M — cn en — —i.. rH cs ^rc. oo *t ■si \o r- co c. vo lClOVC.^Cil» Tt —' ■-. rj-* -]■* VO H cn in oo u. OV tn W 3 o o w H U o z < o l-J < z O H < N < S O K < 8 co m t-h es vo ~r— r- «n es in in rt m vo r- r— r- r- r^ in m m m ov rt Tf es co Ov - m o m m 1 ON „ Os SS r- Ov o es NO NO ncTt-h no es Tt t> oo o t-h t-h cs (s) es r- _■ m vo NO NOVOnOvonOvO ov „a\ -v_j^_. ,. _, .. „ „ c*. •■. i mesmcovovoTt© csocovom© c-k Ov © t-h t—< p-J cs csro vo VO vo vo NO m Ov vo m co co __rt vo es vo eo vo c ..co T co T i O VO ND so © v to CO in m 2 3 NO vo t-Tv es CO ON N vo r- © c_ oo © o o m r- oo oo VO vo vO vO 51| a^s S « JJ o o C 00 3 OQ 5?-a ^ .=7 O d -d J= " .S3 .2 —' .2 t. w o§!.| SJ3-S.S £ fl is g rt so" O ■flTj o .S zi o o rt co 00 M s .a +3 .ti , ID fl) U. pj T? J_ ' OO V fl) OOO _ ""O a'-a si IZiSi Es a I P. u S a «) o8E £ +j rt *h « CD O J3 § -23 co c_,*o -a to ^ C U fl 3ffirtO(3 I > 2 rt *.-g *. c3 cn o d o ■Sift B -* ft 00 n 3 •a c o '■{3 o c >. fl F .9 r TJ 5 a s P G d c rt 1 C S-9 'E q 2 3 ■a 3 a »« ■ « a o a' M fl) £ > A ftg i rt >^ i__ Jr; >£ | 3 S3 ih oo-o cj rt fa a 2 o els a co o to CJ mJ2 CO ■§ O Ih Sis S3 S- 1° • s_ Sfi Sf gg .a Oftg OJ t*H 3 MO & rt - e •S.S § a si HI rt oo-,' rt J S|! g.S|. •2 Si. s „ a o. S a BI' o a o a^S gg o -So 33 - O ft __ 'S 3 8 * rt >^ >>%. H t. M OJ OJ T3 6.Sho<qoS rt ^j «9 6 u S a on o o a a ■111 ..&t JO aj O Ssa rt o 5 81?' >. s >:! S £ fl) > S| ■ Aj rt "3 ■ 0 EQ" 111' 3 rt in vo t> co . ;rJcScscseScseSeseoeocococofri'-?co cococOrl-Ttrt rt HOSPITAL INSURANCE SERVICE, 1970 P 59 inTtoo^Ovrtcoinvor^t^coescOT-Hes rtmco ©©m'ddo©^©©©^©©©© ©"do q o q © o do© eS O es o co m co cs no es eo t-. © en h t-: d ^ ^t ^^^.<r.r^,-.v£.r*_r~.Tj!'-.ri'-.T~.'^_r*_,r_ dc'rt'ddddT-H"do"©T-^d©dd do© © o © © © © es y y tm r-; es" © es co th t> CO 00_ t-H © rH d T-i Ovr^OOcortvD>-^vOT-HVOcor-;OOONr--co Tt Ov CO t—'OvcovoodcocoOv'noscsvovDTtcooomoo T-H Hf^^ rllS ri ,_, fr, ,_,,_, _ ^-, in rt; vci co CS in tj m" ©' f- t~; f-; t-h Tt_ t-h m" ov c^i On t-h co es no i iNOONt-VOVOTtCOTj-rH© OVTtCO © ON r- o oo es vc in t-h On r- eo co vo in t^ co co m t~- cc ti so tn asm co est— © mOvino^m ©rtOvr- r-m t-h co" es" oo" es" es" no" co" es" t-h" o" © rt rtooTt m eS © m Tin in vor-csoooNt-Ttmt—T-HT-Hvomeortm t—t-m rttsvooOT-HT-Hnvooov':tcSinco©oov meSco in rt r^ t-h in t-h ^h r-t-h es m^ © t-h nB £3 co rt^ © t-h tH t-h" Tt" t-h" t-h" th* ,-~ co" r-f t-H CS in t-h" th' t-H »<s © ) TH -5 © es co oo r- vom oo r) mesesr-Tt ovvoooeS co es vp co^ov co no r-o^ r-" t~- t£ m" es rt* es' co" «. •S cs jr CO ON 00 ON O CO 55:5 © © © ON © T-H vor-t^ co _ r" es I r- eS eo c- r-invoi-i ' —1 t-h _ i es es co .JOS, on on 6^£e;«« ■■ — -*- co -h »„ r- r- ov es r- Imrt | mmm i u; in > - esr-r»©o.t-t-r-cot-t--r- ^ *" 1 *t-1 a" •> - J. "t -* J J. © cs s r- r- y © .-= mmi^ i m vo vo w \u r-t-»©eo'~-i>r-.5.r~- N>£ OO I Ov I F -on i - rj- ' co r- CO „ r— vp on r- I Ov VP>n Ov r| ^©-iTrtOvOvT-iOv I © © £ © r2 <s es ,,cScoco| *rJrt „ , I tjU | 1A JI *• ..r-Npovr-lov ^Ov'T r^^-Ho^^^^o^S^ON,Tr-Nf%-oD0'00*j't^t~- • r- © r- es crv A __.__.tt ._.___-, '■ » « in m-rs ■*_ oo _-i.0Nq 00 ON Tt" NO O0 CO 00 0O 00 OO CO J? I '' vp "9 ^ CO COCO C— vp a f- tr~ T3 t- -on "Y i t j „ i r.O\0OiDOQfvl OvOvoino-H^cs t^yooOOOOOOMOO cS* 1 CO OO 00 zz .S o -o ~ •S a rt a « o 3 p a • 2 a i a a 2 a 5?g a- ™ . __ rt o , _. ■— 0) > _. O fl ?-.,_. d ^ _> O -flS„S >,£ £ -a « 0 ,_. I'3 « ra o o t; S E..«« 1 a g ■=> 2 (3 "- J3 rt C ' i_- S rt !J°is fl) fl) > •si s §ll' a I e _> >. cj d S2 •o rt *7_ OJ _3nd U g U tfl U M &*j« fee Sf ^ rt "rt •a b| S w rt u o S c 5J d "° 3 5 -a _i3- oou CO ■c co =, *-; j_3 - *H 1) HH CO -l_t I fi o a o 65 |Soo6q o . . to t— oo.S2 0v©T-Htsco rt rtrt^Ttinminm in ; »- 8 § O a) ' a u *. o _ fl) "go ."° S T3 i 11 g S3 2 rt§s rt DO 4_ •S 5 « Q, 0 _5 n co co "O n a> o S rt rt -2 rt E E J) ■a o o 6 a a a g fl) rt rt a a rt rt -a o .-a ■- a " 3 a a U, D W L, 8 oj » S3 S§§6 OOOO ■a ss _."_. -5 '-g a .S o ; ! »' 4) B T3 rt .- fl) a °S'S rt &u_, a> co n EaE« v. O J) o . u a tfl _. a) a a .3 a __ — E u a) a) fl) ■sS.^ a5 31? a & ° a fl* m o 12 rt > rt X! as > X o .2 a S * h a fl* _ o go . ^ ° c 9 > •oS "■§_• aj^§5 J2 5 E M o) ■? ^8 s| ia a" " a ^ B.5» Jo oal'oS Et^d 3« >.« i- 91- CO _ rH ■< rH « "I d q, S £, & oj in Vh Ih tUUiUi c j= rt E* i oo j rt V \ T_ S ^ i i/i •a i d o rt | «_. C ! o w O T3 h b i d ii s OJ ■=> a.S ■o f- D<R ., E^ ! s o S ! § "tj rt *o j * Ai S •§* ! O^ a. ^ b&"S ^S 3 ^ « B C r- "2 si •S .22 a ternal i iceratic tact ski C 0 t ^ _.s > > J P 60 BRITISH COLUMBIA 13 a ■S c u en Z a. O m M _. o z 3 5 1-1 <j x W N-) OS so en s 2 o c W H < o z o < B. o ca rH z o H < N < cfl O M (fl <h rtn Q t-hi—i-ivpt-h cocoin d © © © © ©dd aj o «s = u eioi > do rto S5 < a o E 3 z th rt r4 q (S CO CS Ov © © © *-. © odd CO NO © Tj- (S t-h T-H CS rtincsinrt 0 co in T-HVPOVVPCO TtOvrt es r^ Tt vo r- oncson **! *» *"* *T >C f'l'^.fS. es" t-h" es on eo es t-h 00 Ov vp coeSONcoin vd vo vo t-h © r- r- vp t—cot-h in tt t-h ir> oc oor-T-H ON Ov o\ ON ON co rt m r- 00 C7v Ov ON ON Ov Z.Z.Z.Z+Z ©00©© CO rt in vo OO Os Os Os Qs Os zzzzz ON NO VO 00 ON ON CO (S CS os as t-h _, „ Z Z >h co in (N CH >H>H 2r~t»c > X HOSPITAL INSURANCE SERVICE, 1970 P 61 STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR THE FISCAL YEAR ENDED MARCH 31, 1970 Administration- Salaries $873,411.00 Temporary assistance 7,633.00 $881,044.00 Office expense 60,080.00 Travelling expense 59,101.00 Office furniture and equipment 14,393.00 Printing and publications 2,677.00 Tabulating and rentals 3,806.00 Motor-vehicles and accessories 2,356.00 Incidentals and contingencies 879.00 Construction and consultation fees 60,995.00 Technical surveys 50,587.00 $1,135,918.00 Payments to hospitals 155,782,683.00 Grants in aid of construction 1,982,409.00 Total $158,901,010.00 Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1971 780-1170-8687
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Twenty-second Annual Report British Columbia Hospital Insurance Service JANUARY 1 TO DECEMBER 31 1970 British Columbia. Legislative Assembly 1971
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Title | Twenty-second Annual Report British Columbia Hospital Insurance Service JANUARY 1 TO DECEMBER 31 1970 |
Alternate Title | HOSPITAL INSURANCE SERVICE, 1970 |
Creator |
British Columbia. Legislative Assembly |
Publisher | Victoria, BC : Government Printer |
Date Issued | 1971 |
Genre |
Legislative proceedings |
Type |
Text |
FileFormat | application/pdf |
Language | English |
Identifier | J110.L5 S7 1971_V01_13_P1_P61 |
Collection |
Sessional Papers of the Province of British Columbia |
Source | Original Format: Legislative Assembly of British Columbia. Library. Sessional Papers of the Province of British Columbia |
Date Available | 2018-10-30 |
Provider | Vancouver: University of British Columbia Library |
Rights | Images provided for research and reference use only. For permission to publish, copy or otherwise distribute these images please contact the Legislative Library of British Columbia |
CatalogueRecord | http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1198198 |
DOI | 10.14288/1.0373687 |
AggregatedSourceRepository | CONTENTdm |
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https://iiif.library.ubc.ca/presentation/cdm.bcsessional.1-0373687/manifest