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Twenty-sixth Annual Report British Columbia Hospital Insurance Service JANUARY 1 TO DECEMBER 31 1974 British Columbia. Legislative Assembly 1975

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 PROVINCE OF BRITISH COLUMBIA
HOSPITAL INSURANCE ACT
Twenty-sixth Annual Report
British Columbia
Hospital Insurance Service
JANUARY 1 TO DECEMBER 31
1974
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1975
  Victoria, B.C., January 20, 1975.
To Colonel the Honourable Walter S. Owen, 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-sixth Annual Report
of the British Columbia Hospital Insurance Service covering the calendar year 1974.
DENNIS G. COCKE
Minister of Health
  British Columbia Hospital Insurance Service,
Victoria, B.C., January 20,1975.
The Honourable Dennis G. Cocke,
Minister of Health,
Parliament Buildings, Victoria, B.C.
Sir: I have the honour to present herewith the Report of the British Columbia
Hospital Insurance Service covering the calendar year 1974.
WILLIAM J. LYLE, F.C.I.S.
Deputy Minister of Hospital Insurance
  ■.':;-..■ S: '''':
The Honourable Dennis G. Cocke, Minister of Health.
  DEPARTMENT OF HEALTH
BRITISH COLUMBIA HOSPITAL INSURANCE SERVICE
The Honourable Dennis G. Cocke, Minister of Health.
Senior Administrative Staff
W. J. Lyle, F.C.I.S., Deputy Minister of Hospital Insurance.
J. W. Mainguy,* B.A., M.H.A., Assistant Deputy Minister of Hospital Insurance.
C. F. Ballam, M.D., Senior Medical Consultant.
N. S. Wallace, C.G.A., Director, Hospital Finance Division.
K. G. Wiper, Director, Administrative Services.
P. Breel, Director, Hospital Consultation and Inspection Division.
D. S. Thomson, B.A., M.P.A., Director, Research Division.
J. G. Glenwright, Director, Hospital Construction and Planning Division.
D. M. N. Longridge, M.A., B.Ch., F.R.C.S., Medical Consultant.
D. E. Mackay, M.D., C.R.C.P.(C)., Medical Consultant (Extended Care).
' Mr. Mainguy left this position in July 1974 upon being appointed Consultant to the Minister of Health.
  CONTENTS
Page
General Introduction  15
British Columbia Regional Hospital Districts Act  19
British Columbia Regional Hospital Districts Financing Authority Act  20
The Hospital Insurance Act  20
The Hospital Act  21
Persons Entitled to or Excluded From the Benefits Under the Hospital Insurance
Act  21
Entitled to Benefits  21
Excluded From Benefits  22
Hospital Benefits Available in British Columbia  22
In-patient Benefits  22
Other Benefits  22
Application for Hospital Insurance Benefits.
23
The Hospital Rate Board and Methods of Payment to Hospitals  24
BCHIS Planning Group  24
Organization and Administration  25
Hospital Consultation and Inspection Division  25
Research Division  28
Hospital Finance Division
  29
Hospital Accounting.-.   31
Hospital Claims Section  31
Hospital Construction and Planning Division  33
Hospital Projects Completed During 1974  35
Hospital Projects Under Construction at Year-end  39
Projects out to Tender at Year-end  40
Projects in Advanced Stages of Planning  40
Additional Projects in Various Planning Stages  40
Medical Consultation Division  42
Administration Division  44
Eligibility Representatives' Section  45
Third-party Liability Section  45
General Office  46
Information Office  46
Approved Hospitals
  46
Public Hospitals  46
Outpost Hospitals  47
Federal Hospitals  48
Rehabilitation Hospitals  48
Extended-care Hospitals  48
11
 J 12 BRITISH COLUMBIA
Statistical Data  49
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)  50
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)  51
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 Covered Population  52
Table 2b—Summary of the Number of BCHIS In-patients and Outpatients  53
Table 2c—Summary of BCHIS Out-patient Treatments by Category, Years
1971-74, Inclusive  53
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 1974 (Excluding Extended-care Hospitals)  54
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 1974 (Excluding Extended-care Hospitals)  54
Charts  55
I—Percentage Distribution of Days of Care by Major Diagnostic Groups,
1973  56
II—Percentage Age Distribution of Male and Female Hospital Cases and
Days of Care, 1973  57
III—Percentage Distribution of Hospital Cases by Type of Clinical Service,
1973  58
IV—Percentage Distribution of Hospital Days by Type of Clinical Service,
1973  59
V—Average Length of Stay of Cases in Hospitals in British Columbia by
Major Diagnostic Groups, 1973 (Excluding Newborns)  60
Hospitalization by Major Diagnostic Categories, 1973 (Excluding Newborns) 61
Statement of Receipts and Disbursements for the Fiscal Year Ended March 31,
1974  67
 HOSPITAL INSURANCE SERVICE,  1974
J  13
:iii:
The Honourable Daniel J. MacDonald, Minister of Veterans Affairs, and the Honourable
Dennis G. Cocke, Minister of Health, photographed during the ceremonies which transferred
the Shaughnessy Hospital from Federal to Provincial jurisdiction.
  Twenty-sixth Annual Report of the
British Columbia Hospital Insurance Service
GENERAL INTRODUCTION
Wm. J. Lyle, F.C.I.S., Deputy Minister
The British Columbia hospital construction programme, since January 1, 1949, has produced a total
of 13,568 beds (acute and extended care) at a total
cost of nearly $260,000,000. In latter years, most of
these projects have been financed by the Provincial
Government through regional hospital districts, with the
Province contributing 60 per cent of the approved cost
and the regional hospital district the remaining 40
per cent.
In the past year, a new hospital was completed at
Fernie.   Major additions and renovation projects were
completed at Abbotsford, Campbell River, Kamloops,
Lillooet, Prince George, and in Victoria at the Royal
"*■** *: ■    Jubilee and Victoria General Hospitals.   New extended-
care facilities were completed in Maple Ridge, St. Vincent's Hospital (Vancouver),
Vernon, and on the Saanich Peninsula, and extensive alterations and improvements
were made to Mount St. Francis Hospital, Nelson. In addition, at the Children's
Hospital in Vancouver, a Care-by-Parent Unit was established so that parents can
stay with their sick children and assist in their treatment.
These projects involved a total of 717 new acute- and extended-care beds, and
construction costs were approximately $22,000,000. At the end of the year, hospital space to provide some 670 acute- and extended-care beds was under construction throughout the Province, and projects involving 715 new beds were in advanced
stages of planning. In addition, the Provincial Government, in its efforts to increase
extended-care facilities, has continued to negotiate for the purchase of suitable
private hospitals. The Glengarry Private Hospital in Victoria was acquired in 1974
by the Provincial Government and the Capital Regional Hospital District, and this
purchase added 75 beds for extended-care patients. During the year the Service
endeavoured to persuade the Greater Vancouver Regional Hospital District, which
has a long waiting-list of persons seeking extended-care accommodation, to participate in the purchase of suitable private hospitals for this purpose. Toward the end
of the year it appeared that the Regional Hospital District Board would be prepared,
in a limited number of cases, to share in the capital costs involved in this approach,
which would almost immediately provide additional accommodation for patients
requiring extended hospital care.
It should be borne in mind that the majority of new in-patient hospital accommodation relates to replacement beds, acute psychiatric and activation and rehabilitation programmes, with few additional general hospital beds being provided for
increased population. The more effective utilization of general hospitals, the
expanded coverage of out-patient care by British Columbia Hospital Insurance
Service, and the greater availability of extended-care beds are having an impact on
15
 J 16 BRITISH COLUMBIA
the need for acute accommodation. It can be seen from Table 2a on page 52 regarding total patient-days that the opening of new extended-care beds enabled the
hospitals to provide an increase of 142,000 days of care for extended-care patients
in 1974 over the care provided in 1973. Also, it should be noted that acute-care
patient-days for adults and children in British Columbia public hospitals actually
decreased by approximately 22,000 despite an increase in population, after taking
into consideration that two Federal hospitals (Shaughnessy and Veterans) were
transferred to Provincial jurisdiction during the year, resulting in a shift of 47,683
patient-days to the British Columbia public hospital category. Another significant
factor, resulting in part from extended-care patients being transferred from general
hospitals, is that the average days of stay for adults and children in British Columbia
public hospitals has been steadily decreasing since the inception of the British Columbia Hospital Insurance Service, resulting in an all-time low of 8.50 days in 1974.
See Table 2c on page 53 regarding ambulatory services, also narrative in statistical
data on page 51.
Included in the alternative types of care is day-care surgery, which has been
provided as an insured benefit since 1968. The purpose is to avoid unnecessary
in-patient hospitalization for certain surgical procedures. The success of the programme is perhaps best reflected in the increasing use of the service. In 1968,
13,450 procedures were performed on a day-care basis; in 1974, over 50,000
procedures were carried out under the programme. The average patient stay for
most of the surgery performed was formerly two to three days, so that a considerable
saving in in-patient care has been achieved through the day-care surgical service.
As mentioned in our 1973 Report three intermediate-care hospitals being
built by the Government and located in Vancouver, Burnaby, and Kamloops, were
assigned to the Hospital Insurance Service. The intermediate-care hospital of
150 beds in Vancouver is fully occupied and operational, in Burnaby the 150-bed
hospital is in the process of being fully occupied and operational, and the Kamloops
facility was officially opened in December 1974, to provide up to 200 beds.
During the year the student bursary programme was expanded to provide
bursaries of $150 per month to para-medical students at the University of British
Columbia, B.C. Institute of Technology, and community colleges, taking the following courses: Registered Nurses and Bachelors of Science in Nursing, Medical
Laboratory Technologists, X-Ray Technicians, Biomedical Electronic Technicians,
Medical Records Technicians, Psychiatric Nursing, Practical Nursing, Physiotherapy, Occupational Therapy, Audiology, and Speech Therapy. A bursary of
$200 per month is paid to students at the University of British Columbia who are
working toward their masters degree in nursing.
By Order in Council passed in August 1974 the formula, under which equipment grants are paid to hospitals, was changed. This enables the Hospital Insurance
Service to pay a 75-per-cent grant on major diagnostic equipment used in pathology,
radiology, nuclear medicine, and ultra-sound procedures. It also enables the Service
to pay a 100-per-cent grant where the equipment is to be used in a satellite diagnostic
out-patient facility, operated by a hospital but situated elsewhere than on the site
of that hospital. This complements the 100-per-cent grant authorized in 1973 on
approved equipment where the equipment purchase will result in savings of approved
operating costs which will recover the capital cost in a reasonable time. The 33J/^-
per-cent grant on all other movable depreciable equipment still applies. Hospitals
also receive in the approved budget a per diem equipment replacement allowance
and this was substantially increased in 1974 to 60, 20, and 15 cents a patient-day
for acute, rehabilitation, and extended-care hospitals respectively.
 HOSPITAL INSURANCE SERVICE,  1974
J  17
After lengthy negotiations, Shaughnessy Hospital in Vancouver (including the
George Derby Unit, Burnaby) and Veterans' Hospital in Victoria were transferred
from Federal to Provincial jurisdiction in 1974. Separate ceremonies to commemorate the transfers were held at the Veterans' Hospital on October 3 and at
Shaughnessy Hospital on October 4. In joint statements issued by the Honourable
Daniel L. MacDonald, Minister of Veterans Affairs, Ottawa, and the Honourable
Dennis G. Cocke, it was stressed that priority will continue to be given to war
veterans under the terms of the transfer agreements, 870 beds being allocated for
the acute and long-term care of veterans in Vancouver, and 170 beds in Victoria.
When these beds are not required by veterans, they will become available for community use. The welfare of Department of Veterans Affairs hospital workers
affected by the transfers was also a matter of prime concern to the negotiators for
the two Governments, great care being taken to insure that minimal disruption
would take place.
The Provincial Government has leased the hospitals to local organizations on
a long-term basis for a nominal sum. Shaughnessy Hospital has become part of the
British Columbia Medical Centre complex, and its extensive grounds (43 acres)
will provide an ideal site for the future expansion of the hospital and the other
activities of the Centre. Veterans' Hospital, Victoria, is now being operated by
the Royal Jubilee Hospital, and is known as the Memorial Pavilion.
In 1973, by an Act of the Legislative Assembly, the British Columbia Medical
Centre was established as a corporation to operate a medical and health sciences
centre for the Province, in Vancouver. Facilities affiliated with the centre include
the Vancouver General Hospital, St. Paul's Hospital, Shaughnessy Hospital, Children's Hospital, the British Columbia Cancer Institute, the G. F. Strong Rehabilitation Centre, and the University of British Columbia Health Sciences Centre Hospital.
The corporation comprises a Board of Directors of 12 persons appointed by the
Lieutenant-Governor in Council and includes outstanding professional and business
people who are involved in the health and hospital field.
The Board is responsible for the co-ordination of planning for the hospitals
mentioned above, and in addition, has direct operating responsibility for the
Shaughnessy Hospital, the former military hospital which was transferred from the
Federal to the Provincial Government in July 1974 for operation as a public hospital. Significant progress has been made in planning for the efficient integration
of hospital services among the institutions affiliated with the Centre for which the
Provincial Government has authorized a total of 2,850 acute, activation, and rehabilitation beds.
The first phase of a project at Shaughnessy Hospital will provide 180 children's
beds and a 120-bed maternity unit to form a maternal-pEediatric facility at this
hospital, which has been allocated 1,120 of the beds authorized for the member
institutions. St. Paul's Hospital will be a 600-bed facility and will become the
major ambulatory care centre, although the other hospitals affiliated with the Medical
Centre will also provide this service. Vancouver General Hospital will provide 970
beds, and be the major trauma, emergency, and surgical service centre, the surgical
role being heavily emphasized. The G. F. Strong Rehabilitation Centre will be a
100-bed facility, and the 60 psychiatric beds at the Health Sciences Centre, UBC,
are also included in the complex. During the year, approval was given to the
construction of a facility to provide 296 extended-care beds at the University of
British Columbia. This extended-care hospital plus 200 beds at the Banfield
Pavilion, Vancouver General Hospital, and 100 beds of the 300-bed Queens Park
Hospital, now being planned for the New Westminster Coquitlam area, have been
designated for the teaching of health care students.
 J  18 BRITISH COLUMBIA
Reference was made in last year's report (page Q 14) to the planned formation
of a British Columbia Cancer Control Agency. On October 31, 1974, the British
Columbia Cancer Institute, Vancouver, was transferred to the Province by the
British Columbia Cancer Treatment and Research Foundation. On the same day
the Institute property was leased for a nominal sum to the Cancer Control Agency
of British Columbia, a society incorporated in September 1974 for the purpose of
carrying out, in conjunction with the operation of the Institute, a significantly expanded Province-wide programme of cancer care and control announced earlier
this year by the Minister.
At the Spring Session of the Legislative Assembly the Regional Hospital Districts Act, which governs the functions and sets out the powers of regional hospital
district boards in raising capital funds for hospital projects, was amended to remove
the requirement that borrowing by-laws be approved by the owner-electors before
being adopted. The approval of the Lieutenant-Governor in Council is required,
and capital expense proposals, describing the projects to be provided and
stating the amount to be borrowed for this purpose, must be published beforehand.
The procedure will be similar to that now provided for raising capital funds for
school construction projects, and will allow regional hospital district boards to plan
for individual projects as well as for groups of projects located throughout the
District. A further amendment allows the Minister of Health to designate as
"hospitals" other types of health facilities, so that capital financing may be provided
under this Act.
For the second year, the student summer employment programme sponsored
by the Provincial Government provided funds to hospitals. Our Service again administered the appropriation for hospitals, and under this programme it is estimated
that the cost in this fiscal year will exceed $1,700,000 in providing employment
for summer students.
Operating and capital costs for hospitals continue to increase from year to
year, and with over 80 per cent operating expenditures relating to salaries and fringe
benefits, we can expect, in the present inflationary climate a further rapid growth
in the cost of providing this labour-intensive health service. Figures in this report
relating to payments made by the Service to hospitals toward operating costs and
equipment purchases, and to regional hospital districts toward construction costs,
reflect these increases, which are due in part to the above-mentioned steadily rising
costs for labour and services and for materials, and in part to the increase in the
number and size of hospitals and the services provided. In the current fiscal year
ending March 31, 1975, an estimated $359,000,000 will be paid by this Service
to hospitals toward expenses incurred by residents of the Province. Daily payments
for hospital care of residents have increased from $50,000 in 1949/50, the first
complete fiscal year of coverage, to $983,600 for each of the 365 days in 1974/75.
At the Second 1974 Session of the Legislative Assembly, the Department of
Health Act was amended to allow for a complete reorganization of the Department.
The Honourable Dennis Cocke, Minister of Health, established a Reorganization
Committee in February 1974, comprised of senior officials of the several branches
of the Department, the Medical Services Commission and the Minister's own staff,
with James W. Mainguy, Assistant Deputy Minister of Hospital Insurance, as Chairman. Based on this committee's report, which incorporated some of the recommendations made by Dr. Richard Foulkes in his 1973 Report, a comprehensive plan
for the reorganization of the Department was announced by the Minister early in
October with implementation to take place in due course, following passage of the
necessary legislation.
 HOSPITAL INSURANCE SERVICE,  1974 J  19
The present four branches of the Department of Health, being Public Health,
Mental Health, Hospital Insurance, and Medical Services will be consolidated into
two main branches, a Medical and Hospital Programs Branch and a Community
Health Programs Branch, with a Health Advisory Council to assist the Minister
in long-range planning and development of health services. A Planning and
Management Committee will co-ordinate functions and determine operating policies
for the Department.
There will be a Senior Deputy Minister reporting to the Minister for the over-all
operation of the Department, a Deputy Minister for each branch, and each branch
will consist of two divisions. Mr. Mainguy is to be appointed as the Senior Deputy
Minister.
The Medical and Hospital Programs Branch will include the medical and
hospital insurance programmes, Government health institutions, ambulance services,
diagnostic services, and forensic psychiatric services, while the Community Health
Programs Branch will be responsible for community public health, community
mental health, and certain environmental services.
As in past years the advice of the Laboratory and Radiological Advisory Councils was of great value to this Service and to hospitals, in considering major equipment acquisition and installation proposals. I appreciate, as well, the advice and
support rendered by the many other individuals and organizations, lay and professional, to the people actively engaged in providing hospital services throughout
the Province. The Director of our Hospital Consultation and Inspection Division,
Peter M. Breel, became a Fellow of the American College of Administrators, being
so honoured at the College's annual meeting in Chicago in 1974. In conclusion I
would like to express my appreciation to the loyal and devoted staff of the Hospital
Insurance Service for the way in which they carried out their duties during the past
year.
Reports by the various Divisions which make up this Service commence on
page 25 of this Report, under the heading "Organization and Administration."
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 formula which provides substantial financial assistance from the Provincial
Government toward the capital cost of hospital projects.
As is the case with school construction, each regional hospital district, subject
to the requirements of the Act, is 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, the district is able to raise any funds
immediately required by temporary bank borrowing on a uniform basis. Periodically the Regional Hospital Districts Financing Authority {see page 20) provides
long-term financing by purchasing debentures issued by districts, thus enabling them
to repay their temporary bank borrowings.
Each year the Provincial Government pays through the Hospital Insurance
Service from the Hospital Insurance Fund its share of the amortization cost in
accordance with section 22 of the Act. Each district in turn raises, by taxation, the
remainder of the annual amortization cost required to retire the debentures which
are held by the Financing Authority.
 J 20 BRITISH COLUMBIA
Under the formula the Province pays annually to each district 60 per cent of
the approved net cost of amortizing the district's borrowings for hospital construction projects, after deduction of any 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 hospital projects, 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 is responsible for co-ordinating and evaluating the requests
for funds from hospitals within the district, and for adopting borrowing by-laws,
subject to approvals and conditions required under the Act, in respect of either
single projects or an over-all programme of hospital projects for the district.
Amendments to this Act, passed by the Legislative Assembly in 1974, are
described earlier in this Report.
A hospital society or corporation is not compelled to seek financing under this
Act if the cost of the project, over and above the amount of the Provincial Government grant, can be raised by other means.
BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS
FINANCING AUTHORITY ACT
This Act established a Provincial Government authority similar to the one
set up 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
The British Columbia Hospital Insurance Service is administered under the
provisions of this statute, which also authorizes the establishment of the Hospital
Insurance Fund, from which grants are made to hospitals and regional hospital
districts toward operating expenses and capital costs.
(1) Generally speaking, every permanent resident who has made his
home in British Columbia during the statutory waiting-period is
entitled to benefits under the Act.
(2) Approved hospitals are paid an all-inclusive per diem rate for
medically necessary in-patient care rendered to qualified British
Columbia residents who are suffering from an acute illness or injury,
and those who require active convalescent, rehabilitative, and extended hospital care. The payment made to a hospital by the
British Columbia Hospital Insurance Service from the Hospital Insurance Fund amounts to $1 less than the per diem rate approved
for the particular hospital, and the patient is responsible for paying
 HOSPITAL INSURANCE SERVICE,  1974
J 21
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 and out-patient benefits provided under
the Act is described on the following pages.
(4) Qualified persons who are temporarily absent from British Columbia
are entitled to certain benefits for a period of 12 months following
their departure from the Province.
(5) In addition to the payment toward operating costs, paid to hospitals
as described in (2) above, hospitals and regional hospital districts
receive grants of up to 60 per cent of approved costs of construction
or acquisition of hospitals or hospital facilities, one third of the cost
of minor movable equipment, 75 per cent of the cost of major
diagnostic equipment, and 100 per cent of the cost of equipment
which results in proven savings in operating costs.
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 Act.
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.
(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 hospital insurance coverage.
(3) Rehabilitation and extended-care hospitals. These nonprofit hospitals are primarily for the treatment of persons who require 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 statutory waiting-period (which expires at midnight of the last day of the
second month following the month in which the person moved to
the Province); or
(6) 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
 J 22 BRITISH COLUMBIA
(c) He is living within the Province and is a dependent of a resident of
the Province.
During the statutory waiting-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 20 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 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
Worker's Compensation Act, or a war veteran who receives treatment
for a pensionable disability; or
(/) Persons entitled to receive hospital treatment under the Statutes of
Canada or any other government; for example, members of the
armed forces or Royal Canadian Mounted Police, and consular
officials of other countries.
HOSPITAL BENEFITS AVAILABLE IN BRITISH COLUMBIA
In-patient Benefits
In addition to standard-ward accommodation with meals and necessary nursing
services, a beneficiary may receive any of the other services available in the hospital,
which may include
laboratory and X-ray services;
drugs, biologicals, and related preparations (with a few exceptions);
use of operating-room and caseroom facilities;
use of anaesthetic equipment, supplies, and routine surgical supplies;
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.
Operating-room or emergency-room services for minor surgery, including
application and removal of casts.
 HOSPITAL INSURANCE SERVICE,  1974 J 23
Day-care surgical services are available to patients who require operating-
room or other specialized-treatment facilities, but who can be discharged within 24 hours.
Out-patient cancer therapy is provided by the British Columbia Cancer
Institute of the Cancer Control Agency of British Columbia in Vancouver and Victoria.
Day-care and night-care psychiatric services are available to patients who
come to a designated 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. There are
18 hospitals presently designated to provide this service in the
Province.
Out-patient psychiatric care is available to patients who come to one of
21 designated hospitals for a particular psychiatric service.
A cytology service provides for examination of cervical smears sent by
physicians to the B.C. Cancer Institute for the early detection of
cancer in women. In addition, hospital laboratories perform many
tissue examinations for the detection of a variety of diseases and
conditions.
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 methadone substitution programme established by the Narcotic Addiction Foundation of British Columbia is available at six centres in the
Province.
Coverage for diabetic day-care services is available in a number of the
larger hospitals in the Province.
Day-care services at The Arthritis Centre of British Columbia, Vancouver,
which is operated by the Canadian Arthritis and Rheumatism Society,
British Columbia Division, is under hospital insurance coverage.
This centre provides physiotherapy and other services on an outpatient basis to persons suffering from arthritis and rheumatism.
Out-patient physiotherapy service is provided by hospitals.
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 payable by the Medical Services Commission or the Overall British Columbia
Medical Plan, subject to payment of premiums by the patient. Nonbeneficiaries
are required to pay the full charge for the hospital services and medical treatment
received.
APPLICATION FOR HOSPITAL INSURANCE BENEFITS
At the time of admission to hospital, a patient wishing to apply for coverage
under the hospital insurance programme is required to make an Application for
Benefits. The hospital is responsible for verifying the patient's statements regarding
length of residence, etc., to determine if the patient is a qualified resident as defined
in the Hospital Insurance Act and regulations. Payment is then requested by the
hospital from the British Columbia Hospital Insurance Service, which may reject any
account if either the patient's status as a qualified resident or the medical necessity
for his receiving hospital-care benefits has not been satisfactorily established.
 J 24 BRITISH COLUMBIA
THE HOSPITAL RATE BOARD AND METHODS OF
PAYMENT TO HOSPITALS
The Hospital Rate Board, appointed by Order in Council, is responsible for
advising 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
the total of 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 in-patient 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.
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. It is composed of five senior
members of the service.
Planning Group held an average of two meetings per month during the year, in
addition to which members of Planning Group held a number of meetings with
regional hospital district boards or committees and with representatives of hospitals.
 HOSPITAL INSURANCE SERVICE,  1974
ORGANIZATION AND ADMINISTRATION
J 25
The British Columbia Hospital Insurance Service is a branch of the Department
of Health, the other branches being Public Health, Mental Health, and the Overall
Medical Services Plan.
The following reports provide a brief outline of the work carried out during
1974 by the various divisions and offices which comprise the administrative structure
of this branch:
HOSPITAL CONSULTATION AND INSPECTION DIVISION
P. M. Breel, Director
This Division provides public and private hospitals
with consultative services in all matters of hospital
operation and administration. The Division is responsible for an inspectional programme to ensure that basic
standards are met and that private hospitals are appropriately licensed.
The staff is composed of consultants in hospital
administration, nursing, dietetics, laboratory, social services, and management engineering.
The Division co-operates with all other divisions
of this Service in achieving aims of mutual interest and
responsibility. It is responsible for the analysis, and
makes recommendations, relative to hospital staffing
patterns which are considered in establishing approved
operating budgets. The Division is represented on the Hospital Rate Board,
Planning Group, and the Equipment Committee. Staff members participate in the
hospital planning functions of the British Columbia Hospital Insurance Service,
including the review of operational implications of 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.
Heavy commitment to other priorities reduced the consultative and inspectorial
visits to acute, rehabilitation, and extended-care hospitals to 170 in 1974, and
private hospitals giving nursing-home care received 208 visits. Reports recommending ways and means of improving were made both to Government and to the
hospitals, and appropriate follow-up visits and actions were scheduled.
Several hospitals required intensive inspection and consultative visits with
senior members of this Division and the Medical Consultation Division being involved. Hospital board, medical staff, administration, and labour relations continued to present problems which required mediation and assistance of this Division.
Reports and recommendations were made in all instances.
Hospital budget-staffing requests were again scrutinized by the administration
consultants and the continuing evaluation and validation of standards resulted in a
number of changes to allowances to the advantage of our hospitals. Liaison was
maintained by membership in the Radiological Advisory Council, Laboratory Advisory Council, the Community Care Facilities Licensing Board, the British Colum-
 J 26 BRITISH COLUMBIA
bia Health Association Education Committee, Federal and Provincial Pharmacy
Committees, and many other ad hoc boards and committees. The Director of the
Division remains a member of the Federal Advisory Committee on Canadian Health
Standards. Consultants participated in several studies related to health care for
other Governmental departments. An administration consultant transferred to the
Construction Division and an additional administration consultant joined the Service in the fall. Four administration consultant vacancies remained to be filled at
the end of the year.
During 1974 the British Columbia Hospital Insurance Service became actively
involved in the Intermediate Care Programme. A society named the Intercare
Association was established under the Societies Act and a Board of Directors comprised of members of the Hospital Insurance Service named to manage the affairs
of the facilities concerned until such time as community societies and boards could
be formed to assume these responsibilities. Members of the Hospital Consultation
Division working in concert with the Medical Consultation Division have produced an Intermediate Care Programme Guide which, when published, will identify
the needs of this segment of the community, and will serve as a guideline for the
management and operation of intermediate care facilities in British Columbia. In
addition to the programme guide, members of the Division collaborated with
representatives of the Medical Consultation Division, Health Branch, Department of
Human Resources, and Department of Public Works in the production of a building
guide for intermediate care homes. This guideline should be completed in 1975.
An administration consultant was appointed interim administrator of the Dogwood
Lodges and the Kamloops Intermediate/Personal Care Facility. The Dogwood
Lodges are comprised of 152-bed intermediate care facilities, one located at 500
West 57th Avenue, Vancouver, and the other at 3755 Willingdon Avenue, Burnaby.
The Kamloops Intermediate/Personal Care Facility is a 192-bed unit located at
425 Columbia Street, Kamloops. The Dogwood Lodge, Vancouver, opened its
doors to the first resident in June 1974 with the Dogwood Lodge, Burnaby, opening
in October 1974. The Kamloops facility will open early in 1975. These facilities
are innovatively designed to provide a noninstitutional atmosphere for their residents.
The addition of two nursing consultants allowed increased activity in assessing
and improving the quality of patient care in our acute, rehabilitation, extended-care,
and licensed private hospitals. The nursing consultants continued to advise on
matters related to patient-care programmes, staffing, construction plans, and hospital equipment. Active participation was maintained at both National and Provincial levels with the senior consultant meeting with Federal and Provincial senior
nursing consultants to share information and plan for the various health-care services. Other nursing consultant involvement included the Council of Practical
Nurses, Health Security Programme Project Group, Task Committee on Obstetrical
Services of the Capital Regional Board, Task Committee to Review Nursing Care
Manual used by Public Health Nursing Staff, Nursing Advisory Committee of the
British Columbia Institute of Technology, Psychiatric Nursing Liaison Committee,
and Douglas College Nursing Advisory Committee. To maintain the standards of
patient care in licensed private hospitals special follow-up visits were made by
nursing consultants.
The Division's two consultants in dietetics made 72 regular and follow-up
visits to hospitals in 1974. They were involved with counselling students taking the
Canadian Hospital Association Food Service Supervisory correspondence course,
served on a variety of committees at both the National and Provincial levels, reviewed many plans for new and renovated facilities and developed and participated
in dietetic workshops.    The senior dietetic consultant attended the Canadian
 HOSPITAL INSURANCE SERVICE,  1974 J 27
Dietetic Association Annual Meeting in Toronto and was a member of the Federally-
based Working Party studying staffing guidelines for departments of dietetics. Two
work-sampling studies were completed in co-operation with the Division's Management Engineering Unit. The information from these studies along with information
from previous studies will be used to develop a methodology for departments of
dietetics. This year saw the publication of the final report of the Food Production
and Service Study undertaken at Penticton Regional Hospital. The pilot project to
develop a limited commissariat service at Richmond and Surrey Hospitals was also
completed this year. A third consultant in dietetics joined the staff in December
increasing this section's consultative and inspectorial capacity.
The Hospital's Management Engineering Unit has continued to provide for the
needs of both individual hospitals and groups of hospitals whilst operating in close
co-operation with the three Regional Management Engineering Units. The services
of the BCHIS unit have also been provided to other health-care agencies. The
consultative aspects of the unit's work have increased substantially, particularly in
respect to the involvement of the unit's consultants in the process of planning
extensions and renovations to hospitals. Major studies of a research and developmental nature having Province-wide implications have included the production of
the Housekeeping Methodology Manual, the report on patient classification, the
development of O.R. scheduling criteria, the Convenience Food Study at Penticton,
and full-time involvement with the BCHIS Computer Committee. The library
service has distributed 249 copies of the unit's reports to health-care agencies in
the Province. An additional 26 copies have been sent to other provinces and 24
copies have been sold abroad, principally to the United States.
In August a consultant in social work joined the staff, reflecting the Division's
increasing concern about the social and emotional aspects of patient care. This
consultant is available to assist hospitals in social service matters, and has a particular interest in promoting greater co-ordination between hospitals and existing community services. Since joining the Division the socal work consultant has become
involved in the planning of new services, the revision of standards, and the formulation of Division policy on social services.
Two new positions have been approved for consultants in radiology and biomedical electronics. Applications for these positions are presently being screened
and it is hoped that appointments will be made shortly. The laboratory consultant
continues to act as secretary to the Laboratory Advisory Council which has maintained its very active role assisting regional and hospital laboratories. This Council
continues to be involved with the process of equipment approval and, increasingly,
with proposals for computer applications in laboratories.
The Vancouver office of the Division maintained a close watch over the private
hospital field, with more than 200 visits and inspections being completed. Five
private hospitals totalling 145 beds closed down during the year. Special studies
resulted in many instructions and recommendations to improve the quality of
private hospital care with appropriate follow-up action being taken to ensure the
standards were being met and maintained.
Three university students were employed during the summer assisting in data
collection on a work-sampling study of a department of dietetics. These students
also worked with dietetic consultants producing dietetic in-service education aids.
One student provided a complete reorganization and reclassification of the Division
library and a review and sortage of dead storage material in preparation for
relocation.
Members of the Division attended a number of in-service and other educational
sessions to maintain currency in the health-care field, and two staff members have
 J 28 BRITISH COLUMBIA
been accepted as students in the University of Victoria toward a masters degree in
public administration. The director of the Division attended meetings of the
Federal Subcommittee on the Quality of Patient Care and collaborated on the study
of Total Friesen Concept with the Director of the Construction and Planning Division. An intradivisional reorganization produced a redistribution of managerial
responsibilities with the confirmation of the position of Assistant Director.
RESEARCH DIVISION
D. S. Thomson, B.A., M.P.A., Director
The Division performs a statistical resource function for the Service and serves as a focal point for data
collection and analysis. Primarily responsible for examining the need for new hospital beds and services, the
Division is also involved in a wide range of activities.
The preparation of recommendations for new additional hospital capacity in the face of an ever-increasing
range of benefits and services covered by the Hospital
Insurance programme necessitates close liaison at the
hospital, regional, and Provincial level. In spite of a
greater emphasis being given to alternatives to acute inpatient beds in recent years, the growth of the Province
necessitates a continuing review of general hospital bed requirements. Recommendations for additional hospital capacity are placed before the Planning Group of
BCHIS for review through the Director who is a member of the group. During the
course of the year, 23 hospitals were assessed with respect to future needs and
recommendations were prepared for Planning Group.
The Director is also Chairman of a subcommittee of Planning Group dealing
with psychiatric services. This committee, which includes representation from the
Mental Health Branch, as well as the Consultation Division, has prepared a number
of reports during the year recommending acute, in-patient, and day-care psychiatric
programmes.
The Division is also responsible for maintaining and compiling statistical data
relating to all hospitalization in the Province. The admission/separation records
submitted by the hospitals for each patient form the basis of this information. All
diagnoses and operations are coded according to the Eighth Revision of the International Classification of Diseases Adapted (ICDA). Through this classification
system, the incidence of disease is analysed by age, sex, geographical location, as
well as other variables. In connection with morbidity analysis, the Division publishes a number of annual reports. Statistics of Hospital Cases Discharged includes
the standard morbidity tables which all provinces publish and affords an opportunity
to make interprovincial comparisons of hospital data. Statistics of Hospitalized
Accident Cases, which is also prepared annually, provides a broad analytical coverage of hospitalized accident cases by circumstance, type of accident, and nature of
injury. A report of the Day Care Surgery in British Columbia Hospitals is also
prepared by the Division for purposes of showing the potential of this type of service.
In addition to these reports, the Division supplies data to many agencies, both inside
and outside of the Government. The demand for hospital morbidity data continues
to grow and has become particularly useful in the planning of specialized hospital
services.
 HOSPITAL INSURANCE SERVICE, 1974
J 29
The Division assisted Dr. Geoffry C. Robinson, of the Department of Paediatrics,
University of British Columbia, on a number of occasions throughout the year by
developing population estimates and providing detailed statistical information for his
studies on paediatric hospital care in various areas of British Columbia.
Three university students were employed during the summer months in the
Division and worked on projects involving hospital data. Specific studies were
carried out in cancer treatment, and also the incidence of respiratory disease.
Through the use of SPSS programmes, extensive use was made of hospital discharge
data with assistance from the data processing centre.
During the year, the Director was asked by the Reorganization Committee of
the Health Department to chair a Task Force on the Development of a Health Data
Base. The Task Force was composed of representatives of various branches of the
Health Department and examined the needs of each branch on a functional basis.
The Task Force report will form the basis for a modified and integrated management
information system.
The Division also maintains a reporting system for therapeutic abortions performed in hospitals in the Province. During 1973, 9,192 abortions were performed
in British Columbia which represents 27 abortions per 100 live births.
HOSPITAL FINANCE DIVISION
N. S. Wallace, C.G.A., Director
Hospital accounting, processing of hospital budgets, the payment of hospital claims, and financing of
hospital capital projects are the four main functions of
the Hospital Finance Division.
In June of 1974, W. J. Pettit was appointed as
Assistant Director to assist in carrying out the responsibilities of the Division. Mr. Pettit is the former Director of Finance for the Saskatchewan Hospital Services
Plan.
The Finance Division is responsible for reviewing
the annual budgets prepared by regional hospital districts
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 1974 the regional hospital districts debenture
sales to the British Columbia Regional Hospital Districts Financing Authority
amounted to $25,600,000.
The Finance Division is also responsible for the approval of grants to assist
hospitals in the purchase of equipment. An Order in Council was passed in August
1974, under which the equipment grant structure was changed. This enables the
Hospital Insurance Service to pay a 75-per-cent grant on diagnostic equipment used
in pathology, radiology, nuclear medicine, and ultra sound. This also enables the
Service to pay a 100-per-cent grant where the Minister determines that the equipment is to be used in a satellite diagnostic out-patient clinic operated by a hospital,
but which is situated elsewhere than on the site of that hospital. This complements
the 100-per-cent grant on approved equipment where the equipment purchase will
result in savings of approved operating costs and recover the capital cost in a reasonable time, and the 33VS-per-cent grant on all other movable depreciable equipment.
In 1974, after review of approximately 6,500 applications received from hospitals,
grants totalling $3,700,000 were approved on purchases of movable and fixed
technical equipment amounting to approximately $9,000,000.
 J 30 BRITISH COLUMBIA
As a means of assisting hospital staff to maintain high working standards,
the Hospital Insurance Service provided over $300,000 during the year to enable
hospital employees to attend or participate in short-term educational training courses.
It is estimated that the increase in salaries resulting from negotiations concluded by the B.C. Health Association with the Hospital Employee's Union,
Registered Nurses Association of British Columbia, Health Sciences Association,
and sundry other unions and including the Cost of Living Allowance (COLA)
adjustment where applicable, which was effective September 1, 1974, will amount
to $62,000,000 for the calendar year ending December 31, 1974.
Close liaison was continued with the Commissioner of Municipal Superannuation with respect to the application of the Act to hospital personnel and the postponement of retirement for certain employees who reached maximum retirement age.
The Director continued to perform duties as Chairman of the Hospital Rate
Board, Chairman of the BCHIS Computer Committee, and a member of the following committees: Subcommittee 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), the Radiological Advisory Council,
and delegated membership on the B.C. Health Association Computer Committee,
and the Health Services Centre Computer Advisory Committee.
Experience during the first few years' operation of the British Columbia Hospital Insurance 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 1974 amounted to
$337,000,000.
 HOSPITAL INSURANCE SERVICE, 1974
I 31
(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.
(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 Statistics Canada 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 calculation 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 recommendations 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 sixty-two hospital-operating, pre-construction, and regional
hospital district budgets were reviewed and processed in 1974. Inspection visits
were made to each of 114 public general, rehabilitation, and extended-care hospitals
during the year. Construction audits were carried out on major construction projects involving approved expenditure of $13,750,000 and minor projects costing
$256,000. The amount of approved costs shareable with regional hospital districts
is derived from the audit reports.
Hospital Claims Section
V. Richards, Supervisor
The Staff of Hospital Claims is responsible for processing the Admission-
Separation Records (accounts), which hospitals submit for each patient, and for
approving the payment of all acceptable claims. Assistance is provided to hospitals
by this Section as to the proper method of submitting the individual accounts. This
is accomplished by correspondence, telephone, and personal visits.
During the year the Supervisor of Hospital Claims attended an Admitting and
Eligibility Seminar held at Dawson Creek, which was attended by staff of hospitals
in the region. The Supervisor also visited hospitals in the Greater Vancouver area
as well as hospitals on Vancouver Island.
 J 32 BRITISH COLUMBIA
Accounts processed were in excess of 1,950 per working-day, and over 2,000
emergency-service and minor-surgery account forms were handled per working-day.
Discussions with Data Processing Centre were continued during the year regarding the efficient use of electronic data processing equipment in order to refine
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 under the
Hospital Insurance Act. Details of residence are checked with the verifying documents, and as a result over 5,000 claims had to be returned to the hospitals during
the year because they were incomplete or unacceptable, and over 1,500 letters were
written on eligibility, verification, and related matters.
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.
The In-patient Claims Checkers pre-audit the charges made to the British Columbia Hospital Insurance Service, and ensure that all information shown on each
claim is completed so that it can be coded for statistical purposes, also that it is
charged to the correct agency, such as the British Columbia Hospital Insurance Service, Worker's Compensation Board, the Department of Veterans Affairs, or other
provinces and territories. During the year over 5,000 queries were addressed to
British Columbia hospitals on such matters.
In order to further the co-operation between the British Columbia Hospital
Insurance Service and the hospitals the Supervisor of the In-patient Claims Checkers
attended a Regional Seminar at Kelowna which was attended by hospitals in the
area. The Supervisor also visited hospitals on Vancouver Island, the Lower Mainland and the Interior of the Province.
Preliminary figures for 1974 show that more than 460,000 accounts (excluding
out-of-Province) were processed.
The Adjustment Section is responsible for researching and making adjustments
to processed accounts. There was an increase in the number of adjustments due
primarily to changes in responsibility for payment and accounting amendments.
The Day-care Surgical Services, Day-care/Night-care Psychiatric Services, outpatient Psychiatric Services, and Day-care Diabetic Services accounts increased in
volume to over 7,000 per month in 1974. During the year the Service continued
to provide a quarterly statistical run of Day-care Surgical Services for the hospitals
of the Province.
A service for out-patient physiotherapy patients was provided during the year
and preliminary figures indicate that accounts for over 280,000 treatments will be
processed this year.
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 the punching of the data processing 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 Service accounts.
During the year the medical plan number of the patient was included with the
statistical information recorded on the data processing card by the key-punch staff.
The out-of-Province personnel process all claims for hospital accounts incurred
by British Columbia residents in hospitals outside the Province. This requires establishing eligibility and the payment of claims.   During 1974 over 500 accounts were
 HOSPITAL INSURANCE SERVICE,  1974
J 33
processed each month, resulting in an estimated expenditure of over $3,500,000.
Accounts were paid on behalf of qualified residents hospitalized in other
provinces and territories of Canada, the United States of America, Australia,
Austria, Bahamas, Belgium, Bermuda, Canary Islands, Denmark, Dominican Republic, Egypt, Eire, England, Finland, France, Guatemala, Germany, Greece,
Guyana, Haiti, Holland, Honduras, Hong Kong, Hungary, India, Iran, Israel, Italy,
Japan, Kenya, Lebanon, Malaysia, Manila, Mexico, New Zealand, Norway, Philippines, Portugal, Rhodesia, Romania, Scotland, Singapore, South Africa, Spain,
Sweden, Switzerland, Taiwan, Tasmania, Thailand, Turkey, West Indies, Yugoslavia.
An up-to-date Hospital Rate Schedule is maintained for every hospital in
Canada. All claims are coded for statistical purposes and a data processing card
is punched for each account.
The Claims Distribution Centre receives, sorts, and distributes all the forms and
correspondence received in the Hospital Claims Section. Over 10,000 claims, documents, and letters are handled daily. In order to handle the increasing volume the
procedures are constantly under review.
HOSPITAL CONSTRUCTION AND
PLANNING DIVISION
 ,. :.;■;■:: |:W .   & .
John Glenwright, Director
The main functions of the Construction and Planning Division can be briefly described as follows.
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 development of master
programmes which contain a clear definition of the
hospital's role, supported by written functional programmes for construction projects related to 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 other
allied organizations, including the Radiological 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 most logical and the 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.
Approximately 170 sets of plans were received by the Division during the year.
These drawings covered many phases of planning, including small-scale schematic
drawings and final working drawings and specifications, including architectural,
mechanical, electrical, and plumbing drawings.
 J 34 BRITISH COLUMBIA
During 1974, 20 hospital construction projects were completed throughout the
Province. These projects resulted in a total of 717 new and replacement beds coming
into service, together with supporting improved and expanded diagnostic, treatment,
and service facilities.
As a result of the spiralling rate of inflation from uncertainties regarding labour
wage settlements, plus the inherent problems related to prices and availability of
materials and supplies during the early part of the year, generally speaking, contractors became extremenly reluctant to undertake major construction projects by
the traditional stipulated sum method. Most of the major projects started this year,
therefore, have been undertaken by the construction management method.
It is expected that the work load of this Division will be increasingly affected
by the reorganization of the Health Department recently announced by the Honourable Dennis Cocke. During the year, this Division was involved in the review of
plans for Intermediate Care Units, since a number of these are being planned
throughout the Province.
The Division works with representatives of hospitals and regional hospital districts in reviewing and processing for consideration by the Government those programmes of proposed capital expenditures. As a result of changes made in the
legislation covering regional hospital districts, capital requirements for hospital
construction projects are now included in Capital Expense Proposals approved by
regional hospital districts.
Continuing benefit was derived during 1974 from the co-operation of the
Department of Public Works in the assignment of architects to this Division. A
third architect, Gines Rivera, was added to the staff at the beginning of February.
Prior to joining this Division, Mr. Rivera has had extensive experience in the
Philippine Islands.
The staff of the Division has been strengthened with the addition of G. F.
Fisher (formerly Administrator, Prince George Regional Hospital) in August to fill
the position of Assistant Director. M. N. Halkett was transferred to become the
Senior Planning Consultant in this Division and C. E. Dosdall (formerly with St.
Paul's Hospital) and E. A. Crump joined the staff as hospital consultants. E. M.
Browning, who had been with the Division since the inception of the Hospital Insurance Service in 1949, retired at the end of January. His position was taken by Mrs.
C. A. Green.   C. N. Beattie retired during the year.
The Director of the Division is Vice-Chairman 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. During the past year the Director has served as a member
of the Canadian Standards Association Sectional Committee on Health Facilities.
The Assistant Director is chairman of the Functional Programme Review Committee.
The Division also has representation on the Equipment Committee, which is a subcommittee of Planning Group. Members of the Division are also involved in the
Systems Advisory Committee which acts as an advisory subcommittee to the Equipment Committee. The Division also has a representative on the Computer Committee which was set up in June to evaluate hospital proposals and advise the Deputy
Minister. M. N. Halkett serves as a member of the Minister's Task Committee on
the British Columbia Medical Centre.
Members of the medical and nursing professions and the staff of the Provincial
Health Branch through the Radiological Advisory Council and the Laboratory
Advisory Council contributed materially to the provision of consultative services to
hospitals.  Also, through the co-operation of the Provincial Department of Labour,
 HOSPITAL INSURANCE SERVICE,  1974
I 35
the Inspector of Factories' office continued to provide a consultative service to this
Division related to proposals for elevators and dumbwaiters.
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.
Studies carried out by electrical consultants and members of this Division
culminated in the release of standards this year covering electrical safety in hospitals.
W. H. Cox is also on a committee composed of consulting engineers, pathologists,
and anaesthesiologists making recommendations for ventilation procedures in operating rooms. These studies and those on biomedical electronics are all designed to
provide a safer environment for the patient.
During the year, engineering consulting staff visited most hospitals in the Province to inspect and advise on their mechanical and electrical systems.
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.
During 1974 the Director, architects, and hospital consultants made a number
of inspectional, advisory, and educational visits to hospitals throughout the Province.
In November, M. N. Halkett, joined a team from the British Columbia Medical
Centre, who visited seven new hospitals and medical centres in the eastern United
States.
(a) Hospital Projects Completed During 1974
Matsqui-Sumas-Abbotsford General Hospital, Abbotsford—A large dietary
expansion programme was completed this year which will provide additional services
necessitated by the addition of the new 75-bed extended-care unit now under construction.
Armstrong and Spallumcheen Hospital—This year a programme of renovations
was completed which included alterations to the kitchen/dining area, the lower floor,
and the replacement of windows and provision of air conditioning units for the
general ward areas on the main floor.
Campbell River and District General Hospital—The hospital occupied the new
30-bed addition on November 7, 1974. Completion of this addition and expansion
of services project were delayed by slow delivery of equipment and general labour
problems during the spring and summer.
Saanich Peninsula Hospital, Central Saanich—This new 75-bed extended-care
hospital, which serves the Saanich Peninsula, was officially opened on February 8,
1974, by the Honourable Dennis G. Cocke.
Fernie Memorial Hospital—On June 22, 1974, John Glenwright, Director of
the Construction and Planning Division, officially opened this new 66-bed hospital,
replacing the old 43-bed facility.
Royal Inland Hospital, Kamloops—A ninth floor addition to the 1965 acute
block was completed and the first patients admitted on December 2, 1974. This
brings the total capacity of the hospital to 381 acute beds.
Lillooet District Hospital—Expansion of the acute hospital to 35 acute beds,
plus three extended-care beds, and alterations to provide improved diagnostic, treatment, and service facilities was completed this year. The Honourable W. L. Hartley,
Minister of Public Works, presided at the official opening ceremonies on December
7, 1974.
 Major Hospital Projects, 1974
Completed—Abbotsford, Campbell River, Central Saanich, Fernie, Kamloops,
Lillooet, Maple Ridge, Prince George, Nelson (Kootenay Lake District, Mount St.
Francis), Richmond, Vancouver (Children's, St. Vincent's), Vemon, Victoria
(Royal Jubilee, Victoria General), and Williams Lake.
Under construction—Abbotsford, Chilliwack, Fort St. John, Grand Forks,
Kamloops, Kitimat, Langley, Nakusp, Nelson (Kootenay Lake District), New
Westminster (Royal Columbian), North Vancouver (Lions Gate), 100 Mile House,
Powell River, Prince George, Smithers, Trail, Vancouver (Holy Family, Mount St.
Joseph, St. Vincent's, Vancouver General), Vernon.
For details, see pages 35-42.
'*      .* :-,
'^••,./V'--:
Vernon Jubilee Hospital (the new extended-care unit for adults and children).
(Architects: Paul Smith Associates.)
The new Fernie Memorial Hospital.   (Architects: Paul Smith Associates.)
 ST. VINCENT'S HOSPITAL EXPANSION
The extended-care unit and psychiatric unit at St. Vincent's Hospital, Vancouver.
(Architects: Thompson, Berwick, Pratt & Partners.)
The enlarged Prince George Regional Hospital showing the existing hospital and the
recently completed west wing.   (Architect: Desmond J. Parker.)
-WBPt
Saanich Peninsula Hospital in Central Saanich provides extended care for the area.
(Architects: Wagg & Hambleton.)
 J 38 BRITISH COLUMBIA
Maple Ridge Hospital—The first patients were admitted to the new 75-bed
extended care wing March 18, 1974. As part of the programme the dietary department was expanded and renovations were undertaken in the administration area.
Peter Rolston, M.L.A. for Dewdney, officially opened the new facilities on June 8,
1974.
Kootenay Lake District Hospital, Nelson—On October 15, 1974, a 12-bed
psychiatric unit was opened. The establishment of this unit in part of the unfinished fourth floor in the hospital was Phase I of the major renovation programme
now under way.
Mount St. Francis Hospital, Nelson—A major renovation and improvement
programme was completed to provide upgraded facilities required by the 84-bed
extended-care hospital. The Honourable Lome Nicolson, Minister of Housing,
presided at the opening ceremonies, held June 8, 1974.
Prince George Regional Hospital—Construction of the west wing addition
provided a net gain of 136 beds. Also completed was an enlarged power plant, as
well as dietary, central sterilizing, and laundry departments. The first new beds
were brought into use this spring and the new facilities were officially opened by
the Honourable Dennis G. Cocke, Minister of Health, on October 21, 1974.
Richmond General Hospital—Renovations were completed to provide an improved temporary emergency department. A prefabricated unit was also added to
accommodate the physio-therapy department.
Children's Hospital, Vancouver—On May 12, 1974, the Minister of Health,
the Honourable Dennis G. Cocke, presided at the official opening of the eight-bed
Care-by-Parent Unit and the addition to the registry building which provided classrooms and activity areas.
Grace Hospital, Vancouver—In December of 1974 the hospital completed a
major upgrading of the dietary facilities.
St. Vincent's Hospital, Vancouver—An expansion project was completed
which provided a 75-bed extended-care unit, 20 psychiatric beds, 10 day-care
psychiatric spaces, occupational therapy areas, personnel lockers, storage, as well
as a new dietary department and dining facilities. The new wing was officially
opened on May 26, 1974, by W. J. Lyle, Deputy Minister of Hospital Insurance.
A new staircase in the east wing was also completed to provide a necessary fire
exit for that area.
Vernon Jubilee Hospital—On May 4, 1974, Don Lewis, M.L.A. for Shuswap,
officially opened the new 101-bed extended-care unit, which included 26 extended-
care beds for children. This 26-bed unit is the first extended-care unit designed
for paediatrics to be completed in the Province. The laundry was also expanded to
handle laundry from the enlarged hospital and the Provincial Home at Dellview,
Vernon.
Royal Jubilee Hospital, Victoria—On April 17, 1974, the opening ceremony
took place for the renovated Bay Pavilion, which provides 27 paediatric beds, plus
five acute renal dialysis beds and three beds for a home dialysis programme. The
first patients were admitted April 29, 1974.
Victoria General Hospital, Victoria—An eight-bed intensive-care unit was
completed in the fall of this year.
Cariboo Memorial Hospital, Williams Lake—The hospital recently completed
additions and alterations for a new emergency department, laboratory and central
storage, and a three-bed intensive-care/coronary-care unit.
 HOSPITAL INSURANCE SERVICE,  1974 J 39
(b) Hospital Projects Under Construction at Year-end
Matsqui-Sumas-Abbotsford Hospital, Abbotsford—A new 75-bed extended-
care unit.
Chilliwack General Hospital—Phase IV expansion programme to include a six-
bed intensive-care unit; completion of an unfinished area to provide 10 extended-
care beds; improvement of pasdiatric department and services.
Fort St. John General Hospital—Expansion of their radiology, laboratory,
nuclear medicine, and ambulatory-care facilities and other related work.
Boundary Hospital, Grand Forks—An addition to provide 14 extended-care
beds.
Kitimat General Hospital—Completion of unused portion of third floor and
alterations to remainder of wing to provide 35 extended-care beds; relocation of
maternity department.
Langley Memorial Hospital—Construction of a two-storey addition to provide
ambulatory care and the enlargement of service departments; expansion of the
laboratory; addition to fourth floor and completion of space to provide 49 additional
acute beds for a total of 156, plus four unfinished beds.
Arrow Lakes Hospital, Nakusp—A new 16-bed hospital to replace the
existing 15-bed hospital.
Kootenay Lake District Hospital, Nelson—Phase II of the expansion and renovation programme, including a new Provincial laboratory, expansion of day care,
emergency, radiology, and laundry services. When complete the hospital will have
a total capacity of 116 acute beds, including 12 psychiatric beds.
Royal Columbian Hospital, New Westminster—Addition of prefabricated units
to provide a psychiatric day-care centre.
Lions Gate Hospital, North Vancouver—Phase I—Construction of maintenance shops and linen storage area as part of services for northern expansion
programme.
100 Mile District General Hospital—Expansion to provide a total of 38 acute
beds, and improvement and expansion of diagnostic, treatment, and service facilities.
Powell River General Hospital—An expansion programme to provide a four-
bed intensive care unit; enlargement of the radiology, laboratory, physio-therapy,
pharmacy, and central sterilizing departments; provision of mechanical ventilation
in the 1952 wing and a new pool for hydro-therapy.
Bulkley Valley District Hospital, Smithers—Construction of a new wing containing 57 acute beds to replace most of the existing acute beds, provision of seven
extended-care beds and expansion of services.
Trail Regional Hospital—Construction of a seven-bed intensive-care/coronary-
care unit and a three-bed renal unit.
Holy Family Hospital, Vancouver—Major construction programme to provide
80 activation/rehabilitation beds, plus facilities for a day-care programme, as well
as 154 extended-care beds, some of which are to be provided in the new addition
and some in the existing building.
Mount St. Joseph Hospital, Vancouver—Construction of an addition and conversion of existing extended-care beds to increase the hospital's capacity to 161
acute beds, including 20 psychiatric beds and day-care psychiatric facilities; a new
150-bed extended-care unit; and upgrading and expansion of services.
 J 40 BRITISH COLUMBIA
St. Vincent's Hospital, Vancouver—Phase II of the hospital's expansion programme, involving alterations and renovations to the 1939 east wing, including the
alteration of the old dietary department for ambulatory services; renovation of the
radiology and physio-therapy departments; upgrading the electrical and elevator
services.
Shaughnessy Hospital Vancouver—Renovations to provide a 22-bed spinal
cord injury unit.
Vancouver General Hospital—Renovation of the Willow Pavilion to upgrade
the intensive-care nursery, electrical services, etc.; nuclear medicine facility.
Vernon Jubilee Hospital—-Conversion of existing extended-care unit to provide
38 acute beds; expansion of services, including a new out-patient and diagnostic
services wing, including education and administrative areas; renovations to provide
new physiotherapy and medical records departments; enlargement of the postoperative recovery room, and modernization of the children's ward and central
sterilizing room.
(c) Projects Out to Tender at Year-end
Kelowna General Hospital—Completion of 36 acute beds on the fourth floor
of Block B to be used temporarily as extended-care beds.
(d) Projects in Advanced Stages of Planning
Cumberland General Hospital—Diagnostic and treatment clinic and ambulatory-care facility; intermediate care unit.
Wrinch Memorial Hospital, Hazelton—Replacement of existing building with
a new hospital of 35 acute beds, plus four extended-care beds.
Royal Inland Hospital, Kamloops—Relocation of dietary loading dock; storage
facilities, expansion of diagnostic services.
Kamloops area—New 100-bed extended-care hospital.
Mills Memorial Hospital, Terrace—Extensive renovations to service areas; 25
additional acute beds to be built in "shell"; 16 psychiatric beds, plus six day-care
psychiatric spaces.
Burnaby General Hospital—Two hundred and sixty additional acute beds; expansion of services; ambulatory-care facilities.
Queen's Park Hospital, New Westminster—Three-hundred-bed extended-care
hospital on The Woodlands School site.
Lions Gate Hospital, North Vancouver—Expansion of services, including intensive-care and coronary-care units.
(e) A dditional Projects in Various Planning Stages
Matsqui-Sumas-Abbotsford General Hospital, Abbotsford—Expansion programme to provide additional acute beds and expansion of services.
St. Joseph's General Hospital, Comox—Expansion of diagnostic and treatment
facilities.
Dawson Creek and District Hospital—Expansion and improvement of services.
Cowichan District Hospital, Duncan—Psychiatric unit, including psychiatric
day care; completion of unfinished beds in extended-care unit.
 HOSPITAL INSURANCE SERVICE, 1974 J 41
Elkford—Diagnostic and treatment centre.
Fort Nelson General Hospital—Expansion and renovation, including improvement of services.
Fort St. John General Hospital—Expansion and renovation, including further
improvement of services.
Royal Inland Hospital, Kamloops—Additional beds for a total of 424 acute
beds, plus necessary services.
Kelowna General Hospital—Additional floor on extended-care unit.
Langley Memorial Hospital—Twenty-five additional extended-care beds.
Mackenzie—Twelve additional acute beds with five left unfinished.
Maple Ridge Hospital—Fifty-eight additional acute beds, plus additional floor
in "shell."
Canadian Forces Station Hospital, Masset—Four additional beds.
Mount Waddington Regional Hospital District—Approval to select and acquire
a site and plan a central regional hospital facility.
South Okanagan General Hospital, Oliver—Forty-five-bed extended-care unit.
Pemberton—Diagnostic and treatment centre.
Prince George Regional Hospital—Additional diagnostic and treatment facilities adequate for 500 acute beds; 75-bed extended-care unit.
Princeton General Hospital—Ten extended-care beds.
Sparwood—New 27-bed hospital.
Trail Regional Hospital—Upgrading existing facilities; psychiatric day-care
programme.
Coquitlam and District Hospital—New facility of 150 acute beds and 75
extended-care beds.
Delta Centennial Hospital—Seventy-five-bed extended-care unit; planning for
a Diagnostic and Treatment Centre.
Royal Columbian Hospital, New Westminster—Major expansion of acute beds
and services.
Richmond General Hospital—Addition of 150 acute beds, plus expansion of
services.
Surrey Memorial Hospital—Addition of further 78 extended-care beds on
existing hospital site.
British Columbia Cancer Institute, Vancouver—Provision of 28 additional
beds.
Children's Hospital, Vancouver—Upgrading present hospital to provide improved operating rooms; new infectious diseases unit; planning for a new hospital on
Shaughnessy site (part of B.C. Medical Centre).
Louis Brier Hospital, Vancouver—Addition of 75 extended-care beds.
St. Paul's Hospital, Vancouver—Alterations and improvements to diagnostic,
treatment, laboratory, and service facilities.
Sunny Hill Hospital, Vancouver—Expansion to include 30 extended-care beds,
30 day-care spaces, and expansion of treatment and service facilities.
University of British Columbia, Health Sciences Centre, Vancouver—Two
hundred and ninety-six extended-care beds and facilities.
 J 42 BRITISH COLUMBIA
Vancouver General Hospital—New emergency department, including trauma
and burns unit; ambulatory care; improvement of service facilities; activation unit;
day-care surgery facility, and acupuncture clinic.
Medical Centre of British Columbia (Shaughnessy)—Major referral centre and
teaching facility for the Province.
Mount St. Mary Hospital, Victoria—Renovation programme; centralization of
dietary services.
Royal Jubilee Hospital, Victoria—Approval for master plan; essential renovation and upgrading work.
Cariboo Memorial Hospital, Williams Lake—Additional acute beds.
MEDICAL CONSULTATION DIVISION
Charles F. Ballam, M.D., Senior Medical Consultant
^_____^^ The role of this Division has been comprehen
sively outlined in previous Annual Reports. This year
it is intended to give a brief and general description of
the Division's role and then to list some of the highlights
of the Division's activities during the year.
General—The Division continues to exercise responsibility in its audit function, with review of the
separation records of all patients treated in hospital in
the Province, also with an overview of the initial and
continuing eligibility of patients in long-term care facilities. This audit and control function involves the
Medical Coding Division who review all of the separation data of patients discharged from hospitals, and in
addition to coding this material in preparation for its
incorporation into Provincial hospital data, cases involving long stay, complications,
and other untoward outcomes are referred to a Medical Consultant for review,
and, when indicated, investigation. Because the original data provided from hospitals is based in part on the work of the Medical Record Department in that
hospital, the Medical Consultation Division provides Medical Record Consultation
service to hospitals, and in 1974, upon the retirement of Mrs. Margaret Morrison,
Mrs. Hazel Mlodzianowski assumed this position.
The Central Registry, commenced last year, continues to function and it had
an increase in its responsibility as it now includes applications for all extended-care
hospitals as well as for 700 intermediate-care beds in the Province. The Registry
will have processed approximately 7,000 applications during the current year.
The Division's second role relates to general advice about hospital medical
matters, and this work covers an extremely broad range of consultation. Within the
Service itself, the Division provides consultation on medical aspects affecting other
Divisions, for example, Hospital Construction, both in the matters of renovations,
new building projects, new clinical services, and the like. Consultation and coordination with other branches of the Health Department, as well as with other
agencies, continues. The Division provides physician membership to advisory
committees of the British Columbia Medical Association to Governmental agencies
in a participatory as well as liaison role. The range of consultation involvement
is quite diverse, including regional districts, health agencies, hospitals, and community groups or formal societies requiring consultation or advice concerning
Hospital Insurance involvement in proposed health-care activities.
 HOSPITAL INSURANCE SERVICE, 1974
J 43
Items highlighted from the general work during 1974 would include:
(1) The Division participated in the discussions related to the reorganization
of health services, and has a particular concern for the inclusion in the future of
some Provincial hospitals, such as Riverview, Valleyview, and Pearson Hospital,
into the Division of Hospital Services. During the summer months the Hospital
Insurance Service took over financial responsibility for the Shaughnessy Hospital in
Vancouver, and for the Veterans' Hospital in Victoria, from the Federal Government. Because certain beds are designated as continuing for preferential veterans'
care, the necessity to formulate new policies and to blend existing arrangements in
these hospitals with our own Service requirements, especially in the field of long-term
care, became necessary.
(2) At the Minister's direction, the Division has developed patient eligibility
criteria for intermediate care, and with the inclusion of intermediate care for at least
700 beds in the extended-care registry, a new standard application form has been
developed to cover both these types of care. New descriptive pamphlets in this
connection have been prepared for general information.
(3) The new British Columbia Cancer Agency has taken over responsibility
for cancer-care programmes in the Province, including the operation of the British
Columbia Cancer Institute, and the Medical Consultation Division has had a close
involvement in the proceedings related to these developments.
(4) In the extended-care programme, there are now 49 extended-care units
with approximately 3,326 beds under coverage with very close to 100 per cent
occupancy. In 1974, new units came into operation—Maple Ridge, Haney, St.
Vincent's, and the Saanich Peninsula Hospital in Victoria; also Vernon expanded its
facilities to 100 beds, and included an expanded paediatric unit. Two private hospitals in the Victoria area were changed to extended-care units and are now administered by the Juan de Fuca Hospital Society. At the close of 1974, new construction
or additions to pre-existing facilities included 21 extended-care units which are in
some phase of planning or construction, and these activities will add approximately
1,465 extended-care beds to the present total. During 1974 the Medical Consultation Division undertook 175 hospital consultation visits to extended-care and intermediate-care facilities.
(5) During the year an additional physician was engaged on a part-time basis
in connection with the Division's responsibility for 700 intermediate-care beds. Dr.
J. M. Dickout is currently employed in this part-time work. Additional staffing
increases are anticipated in physiotherapy and occupational therapy, both in connection with the intermediate-care facilities, and also to fill vacancies of staffing in
relation to consultation for the extended-care programme.
(6) The Division has formulated policies for experimental discharge and
short-term admissions under the extended-care programme in recognition of the
fact that many people eligible for extended care could be managed most of the time
in their own homes, and also that there was a need to allow short-term admissions
for such patients to allow for temporary discontinuance of home care when this
became necessary for any number of a variety of reasons.
Quite understandably, in a Province with more than 100 hospitals, problems
relating to hospital administration and medical staff activities occur. The Medical
Division in close co-operation with the Hospital Consultation Division, and with
valued participation from the B.C. Hospital Association, the B.C. Medical Association, and the College of Physicians and Surgeons, have provided assistance in the
resolution of these difficulties.
 J 44 BRITISH COLUMBIA
ADMINISTRATION DIVISION
K. G. Wiper, Director, Administrative Services
The Director 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.
I This officer provides advice and information on a
wide range of matters to the Minister, Deputy Minister,
and other officials of the Department.
Hospital societies and corporations are provided
with assistance in connection with the drafting of his-
pital constitutions and by-laws, and their interpretation
and application. Changes in hospital by-laws are reviewed by this office prior to their submission for
Government approval, as required under the Hospital Act. A set of model by-laws
has been developed for use by hospitals as a guide in making revisions.
Under the Regional Hospital Districts Act, described earlier in this Report,
the staff of this Division worked closely with the officials of other divisions, Government departments, and the various districts in arranging for money by-laws, temporary borrowing, and related matters.
In collaboration with the Hospital Consultation and Inspection Division, this
Division 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. The Division is also involved in the acquisition and disposal
of hospital sites and problems arising in connection therewith. 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 1974 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. The Director was involved in the lengthy negotiations
with Federal Government officials which resulted in the DVA hospitals in Vancouver
and Victoria being transferred to the Provincial Government. The Director was also
a member of the Cancer Control Task Committee which developed the constitution
and by-laws for the Cancer Control Agency of British Columbia, a society incorporated in September 1974 to assume operational control of the British Columbia
Cancer Institute after this hospital was transferred to the Provincial Government by
the British Columbia Cancer Treatment and Research Foundation on October 31.
This Division handles pay and personnel matters concerning the staff of the
Hospital Insurance Service and works closely with the Public Service Commission
and the Finance Department in this regard. The Director is also responsible for
the over-all supervision of the Eligibility and the Third-party Liability Sections and
the General Office.
 HOSPITAL INSURANCE SERVICE, 1974 J 45
Eligibility Section
P. A. Bacon, Supervisor
In order to ensure that only qualified British Columbia residents receive hospital insurance benefits, the staff of the Eligibility Section review the application for
benefits made by, or on behalf of, each person admitted to hospital. A detailed check
is made of all doubtful applications, resulting in the rejection of a considerable number of claims for hospital insurance benefits made by unqualified persons. Numerous
inquiries from the general public with regard to eligibility matters are dealt with by
personal interview, telephone, and correspondence.
Eligibility representatives visit hospitals on a regular schedule to see that the
British Columbia Hospital Insurance Service eligibility procedures are being properly
carried out. The representatives also assist in the training of hospital-admitting
personnel to deal with problems connected with the admission of patients to hospitals
and the determination of their status under the Hospital Insurance Act. This training assistance is provided by means of visits to hospitals and by regional meetings.
This Section initiates all applications to the Health Insurance Supplementary
Fund. This fund was established in Ottawa in order that accounts may be paid for
those Canadians who lose benefits through no fault of their own.
This Section does a detailed check on all applications completed for admission
to an extended-care hospital or unit to ensure residential eligibility.
This Section keeps the greater 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 informaton to the
general public in many communities throughout the Province. Eligibility representatives are located in Prince George, Kamloops, Nelson, Kelowna, Vancouver, and
Victoria.
Third-party Liability Section
J. W. Brayshaw, Supervisor
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. In March the Hospital Insurance Service commenced
dealing with the Insurance Corporation of British Columbia regarding accidental
injury cases which occurred on and after March 1. The Senior Eligibility Representative in Vancouver, 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 in the Lower Mainland area 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, which deals with
cases arising elsewhere in British Columbia.
 J 46
BRITISH COLUMBIA
General Office
K. J. Williams, Supervisor
One of the main responsibilities of the general office is the handling of funds
and the review of requisitions and vouchers submitted by other divisions. These
include travel expenses, requisitions for supplies and equipment, grant payments to
hospitals, and administrative vouchers. These are then forwarded to the appropriate branch of Government for further action. The Supervisor is responsible for
gathering information from all divisions and co-ordinating this material in the
preparation of the annual estimates of the Hospital Insurance Service which are
submitted to treasury board for inclusion in the Provincial Budget. The general
office also handles the storage and dispatch of the various forms supplied by this
Department to hospitals.   Mail is opened, sorted, and distributed in this office.
Information Office
In carrying out information duties during the past year, this office was again
involved with the Health Education Branch in the production of film documentaries.
Administrative arrangements were handled for the Western Interprovincial
Committee Meeting in August, as well as being involved with transfer ceremonies
in October for the changeover of Shaughnessy and Veterans' Hospitals from Federal
to Provincial jurisdiction.
Our Information Officer, C. N. Shave, left the Service late in the year on
promotion to a position with the Department of Transport and Communications.
Regular duties included editing the BCHIS Bulletin, summarizing reports for
the Deputy Minister, some speech writing, and feature items for the Bulletin and
B.C. Medical Journal, and representing BCHIS on the BCHA Information Service,
and BCHA Conference Programme Committees.
In addition, the general information pamphlet was revised and reprinted, and a
pamphlet containing statistical data for hospital personnel was prepared for distribution at the B.C. Hospitals and Health Association Convention in October.
APPROVED HOSPITALS
Public Hospitals
Armstrong   and   Spallumcheen   Hospital,
Armstrong.
Arrow Lakes Hospital, Nakusp.
Ashcroft   and  District   General  Hospital,
Ashcroft.
*Bella Coola General Hospital, Bella Coola.
Boundary Hospital, Grand Forks.
British Columbia Cancer Institute, of the
Cancer Control Agency of British Columbia, Vancouver.
Bulkley Valley District Hospital, Smithers.
*Burnaby General Hospital, Burnaby.
*Burns Lake and District Hospital,  Burns
Lake.
*Campbell River and District General Hospital, Campbell River.
* Hospitals with extended-care units.
Cariboo Memorial Hospital, Williams Lake.
Castlegar and District Hospital, Castlegar.
Chemainus General Hospital, Chemainus.
Chetwynd General Hospital, Chetwynd.
Children's Hospital, Vancouver.
* Chilliwack General Hospital, Chilliwack.
* Cowichan District Hospital, Duncan.
* Cranbrook  and  District   Hospital,   Cran
brook.
Creston Valley Hospital, Creston.
Dawson Creek District Hospital, Dawson
Creek.
Dr. Helmcken Memorial Hospital, Clearwater.
Enderby and District Memorial Hospital,
Enderby.
 HOSPITAL INSURANCE SERVICE,  1974
I 47
Public Hospitals—Continued
Fernie Memorial Hospital, Fernie.
Fort Nelson General Hospital, Fort Nelson.
Fort St. lohn General Hospital, Fort St.
John.
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 District Hospital, Nelson.
Lady Minto Gulf Islands Hospital, Ganges.
Ladysmith and District General Hospital,
Ladysmith.
*Langley Memorial Hospital, Langley.
Lillooet District Hospital, Lillooet.
*Lions Gate Hospital, North Vancouver.
McBride and District Hospital, McBride.
Mackenzie and District Hospital, Mackenzie.
Maple Ridge Hospital, Maple Ridge.
Mater Misericordiae Hospital, The, Rossland.
Matsqui-Sumas Abbotsford General Hospital, Abbotsford.
Michel-Natal District Hospital, Sparwood.
Mills Memorial Hospital, Terrace.
Mission Memorial Hospital, Mission City.
* Mount St. Joseph Hospital, Vancouver.
Nanaimo Regional General Hospital, Nanaimo.
Nicola Valley General Hospital, Merritt.
Ocean Falls General Hospital, Ocean Falls.
100  Mile District  General Hospital,   100
Mile House.
*Peace Arch District Hospital, White Rock.
* Penticton Regional Hospital, Penticton.
Port Alice Hospital, Port Alice.
Port Hardy Hospital, Port Hardy.
* 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.
Queen  Alexandra  Hospital for  Children,
Victoria.
Queen Charlotte Islands General Hospital,
Queen Charlotte City.
Queen Victoria Hospital, Revelstoke.
Rest Haven General 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's General Hospital, Comox.
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.
South Okanagan General Hospital, Oliver.
Squamish General Hospital, Squamish.
Stewart General Hospital, Stewart.
Stuart Lake Hospital, Fort St. James.
Summerland  General   Hospital,   Summer-
land.
*Surrey Memorial Hospital, North Surrey.
Tahsis Hospital, Tahsis.
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.
Victoria General Hospital, Victoria.
Victorian Hospital, Kaslo.
*West Coast General Hospital, Port Alberni.
Windermere District Hospital, Invermere.
Wrinch Memorial Hospital, Hazelton.
Shaughnessy Hospital, Vancouver.
Outpost Hospitals
Red Cross Outpost Nursing Station, Alexis
Creek.
Red Cross Outpost Nursing Station, Atlin.
Red Cross Outpost Nursing Station, Bam-
field.
Red Cross Outpost Nursing Station, Blue
River.
Red Cross Outpost Nursing Station, Edge-
wood.
Red Cross Outpost Nursing Station, Kyu-
quot.
! Hospitals with extended-care units.
 J 48 BRITISH COLUMBIA
Federal Hospitals
tVeterans' Hospital, Victoria. Canadian Forces Station Hospital Masset,
1 Shaughnessy Hospital, Vancouver. Masset.
Canadian Forces Station Hospital Holberg,
San Josef.
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.
Cassiar Asbestos Corporation Private Hos- Mica Creek Private Hospital, Mica Creek,
pital, Cassiar.
Rehabilitation Hospitals
G. F. Strong Rehabilitation Centre, Vancou- * Shaughnessy Hospital, Vancouver.
ver. *Sunny Hill Hospital for Children, Vancou-
*The Gorge Road Hospital, Victoria. ver.
Holy Family Hospital, Vancouver. * Veterans' Hospital, Victoria.
Pearson Hospital (Poliomyelitis Pavilion), (A number of the larger public hospitals
Vancouver. also have rehabilitation units.)
Queen Alexandra  Hospital for Children,
Victoria.
Other
Hollywood Hospital Ltd., New Westminster (licensed under the Mental Health Act).
Extended-care Hospitals
{See also Public Hospitals marked*.)
The Louis Brier Hospital, Vancouver. Pearson   Hospital,   Vancouver    (excluding
Menno Hospital, Abbotsford. facilities for tuberculosis patients).
Mount St. Francis Hospital, Nelson. Priory Hospital, Colwood (24-bed unit and
Mount  St.   Mary  Hospital,   Victoria   (ex- 71-bedunit).
eluding top floor). Glendale Lodge, Victoria.
Mount St. Joseph Hospital, Vancouver. Mount Tolmie Hospital, Victoria.
Glengarry Hospital, Victoria. Saanich Peninsula Hospital, Saanichton.
Out-patient Clinics
Houston Hospital, Houston. Gold River Health Clinic, Gold River.
The Arthritis Centre of British Columbia, Cumberland   General   Hospital,   Cumber-
Vancouver, land.
* Hospitals with extended-care units.
t This hospital was transferred to Provincial jurisdiction August 26, 1974.
t This hospital was transferred to Provincial jurisdiction July 29, 1974.
 HOSPITAL INSURANCE SERVICE, 1974
J 49
STATISTICAL DATA
The tables on the following pages represent statistical data compiled by the
Hospital Finance Division. The data deal with the volume of hospital insurance
coverage provided to the people of British Columbia through the British Columbia
Hospital Insurance Service.
In 1974, there were 113 public general hospitals as well as three diagnostic and
treatment centres, approved to accept British Columbia Hospital Insurance Service
patients. Care was also provided in six Red Cross outpost hospitals, four1 Federal
hospitals, two contract hospitals, five public rehabilitation hospitals, one rehabilitation hospital operated by the Provincial Government, and two specialized outpatient facilities—the Canadian Arthritic Society Vancouver Centre and the Narcotic Addiction Foundation in various centres throughout the Province. Hospital
insurance coverage for patients in nonprofit extended-care hospitals and units commenced December 1, 1965. At the end of 1974, there were 47 hospitals, including
two Provincial hospitals providing extended care.
Data for the year 1974 have been estimated from reports submitted by hospitals
to September 30, 1974, and are subject to minor revision when the actual figures for
the year are submitted.
Table 1a shows that 386,444 BCHIS adult and children patients were discharged (separated) from British Columbia public hospitals in 1974, an increase of
8,725 or 0.02 per cent more than 1973. This table also shows that 95.7 per cent
of the total adult and children patients discharged (separated) from British Columbia public hospitals were covered by hospital insurance, compared to 95.6 per cent
in 1973. Table 1b indicates that in 1974 the British Columbia Hospital Insurance
Service paid public hospitals in British Columbia for 3,282,856 days of care for
adults and children, an increase of 25,750 days or 0.8 per cent more than 1973.
The increase is due primarily to the fact that two large Federal hospitals became
British Columbia public hospitals half way into the 1974 operating year.
As shown in Table 2a, the average length of stay for adult and child patients
in British Columbia public hospitals during 1974 was 8.50 days and the days of care
per thousand population were 1,531. These figures, which show a continuation of
the long-term trend of decreased length of stay, are a result of more effective utilization of hospital beds and ambulatory services. For comparison purposes the data
for extended-care hospitals are not included in the above observations, but it should
be noted that an additional 498 days of care per thousand population were provided
for these patients.
Table 2b is now supplemented by Table 2c as the number and volume of ambulatory services covered by BCHIS have expanded considerably. It should be
noted that psychiatric and diabetic day-care services are only in a limited number
of hospitals. Services listed under "Other" relate to special out-patient services provided by B.C. Cancer Institute, G. F. Strong Rehabilitation Centre, and the Narcotic
Addiction Foundation of British Columbia. The growth of ambulatory services
reflects a trend toward the broader provision of hospital-based services, providing
greater patient convenience and reducing the pressure for construction and maintenance of in-patient beds, which is partially reflected by the reduction in incidence
of patient-days noted above.
i Responsibility was transferred from the Federal Government to the Provincial Government for Shaughnessy and Veterans' Hospital in 1974.
 J 50
BRITISH COLUMBIA
Table 1a—Patients Separated and Proportion Covered by British Columbia Hospital Insurance Service, British Columbia Public General Hospitals'1 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—
1949 	
164,964
216,743
261,128
271,609
277,073
285,998
292,119
301,510
314,585
326,793
338,923
354,766
371,266
380,651
391,732
395,120
403,977
26,272
33,190
39,599
38,226
37,697
37,231
35,688
33,555
32,488
32,014
33,529
36,550
36,931
35,101
34,774
34,544
34,044
191,236
249,933
300,727
309,835
314,770
323,229
327,807
335,065
347,073
358,807
372,452
391,316
408,197
415,752
426,506
429,664
438,021
140,168
199,774
249,654
259,953
264,655
272,597
278,023
286,799
299,518
311,718
324,769
339,409
355,449
364,452
375,373
377,719
386,444
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
95.7
95.8
95.6
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
35,047
33,732
33,595
33,599
33,175
93.8
95.0
98.4
98.3
96.8
96.4
95.8
95.0
94.8
94.9
94.4
94.6
94.9
96.1
96.6
97.3
97.4
164,808
1955 ...    	
1960 	
1961 	
1962
231,289
288,634
297,511
301,160
1963     ....  	
1964 -.
308,475
312,219
1965    	
318,662
1966 ..   	
1967-      ... 	
1968                            	
330,332
342,095
356,404
1969        ....           .    . .... 	
373,985
1970 _	
1971	
390,496
398,184
1972	
19732	
19743	
408,968
411,318
419,619
Percentage of total, patients separated—
1949    	
86.2
1Q55
92.5
1960    :
96.0
1961    	
96.0
1962 	
	
95.7
1963       	
95.4
1964       	
	
	
95.2
1965   	
95.0
19fifi
95.2
1967   	
95.3
1968 	
95.7
1969  -	
	
95.6
i07n
	
	
95.7
1971          	
95.8
1972                          	
1Q712
	
	
95.9
95.7
19743
	
95.8
i Includes rehabilitation hospitals.
2 Amended as per final report received from hospitals.
3 Estimated, based on hospital reports to September 30, 1974.
 HOSPITAL INSURANCE SERVICE,  1974
J 51
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
Hospitals
in Public
Covered by BCHIS
Adults
and
Children
Newborn
Total
Adults
and
Children
Newborn
Total
Patient-days—■
1949 ~~	
1,682,196
2,198,863
2,581,042
2,675,402
2,708,337
2,778,668
2,820,122
2,895,476
3,008,632
3,093,372
3,225,333
3,315,760
3,384,586
3,400,366
3,462,509
3,400,453
3,441,282
213,874
227,674
249,273
240,207
274,032
270,298
260,979
245,756
235,796
239,972
244,715
248,324
253,081
227,372
219,158
214,003
203,731
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
3,637,667
3,627,738
3,681,667
3,614,456
3,645,013
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
3,233,553
3,259,097
3,323,252
3,257,106
3,282,856
85.0
91.2
95.0
95.2
95.0
94.7
94.7
94.0
95.1
95.2
95.3
95.2
94.5
95.8
96.0
95.8
95.5
200,585
212,514
241,157
231,043
263,475
257,736
246,813
230,096
220,270
222,543
226,633
231,803
238,049
216,305
210,764
206,178
197,055
93.8
93.3
96.7
96.1
96.1
95.4
94.6
93.0
93.4
92.7
92.6
93.3
94.1
95.1
96.2
96.3
96.7
1,631,231
1955	
1960
2,217,679
2,692,996
1961    .                                             	
2,777,387
1962                                               _.	
2,837,109
1963                                                 	
2,889,407
1964...              	
2,916,989
1965                                                         	
2,977,328
1966          .     ' -	
3,081,530
1967  	
3,168,543
1968                	
3,301,592
1969                                                 	
3,387,974
1970 	
3,471,602
1971                                                 	
3,475,402
1972                                                .	
3,534,016
19732       ....	
3,463,284
19743                                          	
3,479,911
Percentage of total, patient-days—
1949 - 	
86.0
1955       ....           —.     ....
	
91.4
1960                                                     	
 	
—
95.1
1961                                                  -	
95.3
1962                                                	
95.1
1963                                                 	
	
	
94.8
1964                                             	
94.7
1965                                 .                   -
94.0
1966                                           	
	
	
95.0
1967                                                          	
95.0
1968
95.1
1969                                                   	
95.1
1970                                                	
95.4
1971                                             .   .-	
95.8
1972                                              	
96.0
19732                                           	
95.8
19743                                                 .      . .   .
95.7
i Includes rehabilitation hospitals.
2 Amended as per final report received from hospitals.
3 Estimated, based on hospital reports to September 30, 1974.
 J 52
BRITISH COLUMBIA
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)
B.C. Public
Hospitals
Other B.C. Hospitals,
Including Federal
and Private
Institutions Outside British
Columbia
Extended-
Adults
and
Children
Newborn
Adults
and
Children
Newborn
Adults
and
Children
Newborn
Adults
and
Children
Newborn
Hospitals
(Including
Federal)
Patients-separated—
1949	
1955
149,280
209,999
264,120
273,293
278,021
286,753
293,144
301,522
314,391
325,861
338,706
353,457
369,210
379,144
388,747
392,550
398,529
1,491,121
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
3,465,504
3,486,671
3,543,587
3,474,733
3,449,166
10.03
10.00
10.03
10.09
10.03
9.94
9.91
9.90
9.89
9.79
9.77
9.61
9.39
9.20
9.12
8.85
8.65
24,989
32,035
39,488
37,968
36,942
36,326
34,652
32,240
31,152
30,804
32,031
34,974
35,431
34,192
33,878
33,962
33,468
203,197
215,980
244,480
233,794
266,351
260,771
249,827
232,438
222,475
225,479
229,053
234,098
240,657
218,971
212,549
208,514
198,825
8.13
6.74
6.19
6.16
7.21
7.18
7.21
7.21
7.14
7.32
7.15
6.69
6.79
6.40
6.27
6.14
5.94
140,168
199,774
249,654
259,953
264,655
272,597
278,023
286,799
299,518
311,718
324,769
339,409
355,449
364,452
375,373
377,719
386,444
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
3,233,553
3,259,097
3,323,252
3,257,106
3,282,856
10.21
10.04
9.82
9.80
9.72
9.65
9.60
9.57
9.55
9.45
9.47
9.30
9.10
8.94
8.85
8.62
8.50
24,640
31,515
38,980
37,558
36,505
35,878
34,196
31,863
30,814
30,377
31,635
34,576
35,047
33,732
33,595
33,599
33,175
200,585
212,514
241,157
231,043
263,475
257,736
246,813
230,096
220,270
222,543
226,633
231,803
238,049
216,305
210,764
206,178
197,055
8.14
6.74
6.19
6.15
7.22
7.18
7.22
7.22
7.15
7.32
7.16
6.70
6.79
6.41
6.27
6.14
5.94
7,093
8,313
11,557
10,361
10,226
10,895
11,605
11,417
11,459
9,436
9,310
8,867
8,307
8,654
8,140
8,092
5,835
45,960
75,599
169,401
182,690
183,042
187,714
199,164
205,488
212,413
195,564
188,152
186,565
176,086
167,339
168,950
155,150
103,310
6.48
9.09
14.66
17.63
17.90
17.23
17.16
18.00
18.53
20.72
20.21
21.04
21.20
19.34
20.76
19.17
17.71
151
361
241
151
157
169
149
114
101
83
80
94
87
109
39
34
43
1,146
2,271
1,417
878
850
1,018
878
619
541
451
434
463
450
442
264
172
220
7.59
6.29
5.88
5.81
5.41
6.02
5.89
5.43
5.36
5.43
5.42
4.92
5.34
4.06
6.77
5.06
5.12
2,019
1,912
2,909
2,979
3,140
3,261
3,516
3,306
3,414
4,707
4,627
5,181
5,454
6,038
5,234
6,739
6,250
21,515
19,622
28,889
27,631
32,679
31,174
36,204
32,372
37,028
47,648
46,422
54,269
55,865
60,235
51,385
62,477
63,000
10.66
10.26
9.93
9.27
10.41
9.56
10.30
9.79
10.84
10.12
10.03
10.47
10.24
9.98
9.82
9.27
10.08
198
159
267
259
280
279
307
263
237
344
316
304
297
351
244
329
250
1,466
1,195
1,906
1,873
2,026
2,017
2,136
1,723
1,664
2,485
1,986
1,832
2,158
3,224
1,521
2,164
1,550
7.40
7.52
7.14
7.23
7.24
7.23
6.96
6.55
7.02
7.22
6.28
6.03
7.27
6.34
6.23
6.58
6.20 |
1
	
I960
1961
1962             	
1963	
1964
	
1965 -	
1966..	
1967   -
1968 ...-	
1969	
1970	
1971   --
1972	
19731
" 699
873
990
1,100
1,022
1,495
1,822
2,293
19742    	
2,475
Patient-days—■
1949
1955
1960 	
1961     -	
	
1962...	
1963 - -
1964         	
	
1965           	
1966
305,940
1967.. 	
1968
358,675
409,514
1969 	
1970	
502,365
531,808
1971 -	
1972   	
672,099
817,321
1,044,529
1,187,000
19731
19742 	
Average days of
stay—■
1949 	
1955     	
1960	
1961    —-    -	
	
1962 	
1963  --
1964	
	
1965..     -	
1966	
1967     	
437.68
410 85
1968 	
1969 	
1970. 	
1971 	
1972	
19731   	
413.64
456.70
520.36
449.56
448.58
455 53
19742	
479.60
i Amended as per final reports from hospitals.
2 Estimated, based on hospital reports to September 30, 1974. 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, 1,734; 1971, 1,696; 1972, 1,669; 1973, 1,600; 1974, 1,531, (1954 and subsequent years are based on total population. Because the Armed Forces, Royal Canadian Mounted Police, and
some other groups are not insured under the Provincial plan, the actual incidence of days would be somewhat
higher than shown.) In addition, estimated patient-days per thousand population for extended care amounted to
308 in 1971, 372 in 1972, 454 in 1973, and 498 in 1974. Population figures are revised according to latest census
figures.
 HOSPITAL INSURANCE SERVICE,  1974 J 53
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  .
174,269
242,034
303,608
311,261
314,963
323,079
327,796
333,762
346,242
357,538
371,727
389,531
405,663
414,831
424,447
428,805
434,472
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
292,850
453,589
792,367
985,300
203,269
1955  ....     	
312,587
1960   ....	
1961        -.                                   	
410,920
432,261
1962.   	
1963       ..                           	
442,963
458,079
1964 _                                       .         .
468,796
1965                            	
493,762
1966  	
521,242
1967	
1968       _..   _ 	
552,538
581,727
1969                                  	
609,531
1970 	
1971             	
640,663
707,681
878,036
1,221,172
1,419,772
1972   	
19731  _	
19742  	
1 Amended as per final reports received from hospitals.
2 Estimated, based on hospital reports to September 30, 1974.
Table 2c—Summary of BCHIS Out-patient Treatments by Category,
Years 1971-1974, Inclusive
1971
1972
1973
1974
Psychiatry—■
5,012
7,536
191,113
40,289
7,955
8,131
267,203
44,633
167
8,943
9,277
408,925
50,089
885
162,9972
151,251
12,000
15,500
450 000
55,000
1 300
288,000
Others _ ._	
48,900
125,500
163,500
292,850
453,589
792,367
985,300
i Commenced October 1972.
2 Commenced April 1973.
3 Other includes  (a)   cancer out-patients;   (6)  rehabilitation day care;   (c)   narcotic addiction out-patients
(1972,1973, and 1974 only).
 J 54
BRITISH COLUMBIA
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 191741(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 day's stay—
Adults and children
386,444              207,051
33,175               15,063
3,275,688      |   1,864,443
197,055               96,553
8.48                  9.00
5.94                      6.41
82,388
7,769
644,114
43,074
7.82
5.54
52,618
6,719
467,136
38,644
8.88
5.75
34,608
2,796
242,118
15,327
7.00
5.48
9,779
828
57,877
3,457
5.92
4.18
1 Estimated, based on hospital reports to September 30, 1974.
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 19741 (Excluding Extended-care Hospitals).
Bed Capacity
Total
250 and
Over
100 to 249
50 to 99
25 to 49
Under 25
Patients separated—
Adults and children
Per Cent
100.00
100.00
100.00
100.00
Per Cent
53.58
45.40
56.92
49.00
Per Cent
21.32
23.42
19.66
21.86
Per Cent
13.62
20.25
Per Cent
8.95
8.43
Per Cent
2.53
2.50
Patient-days—
Adults and children
14.26        |          7.39
19.61          I           7.78
1.77
1.75
i Estimated, based on hospital reports to September 30, 1974.
 HOSPITAL INSURANCE SERVICE, 1974
J 55
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 63 to 67 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 1973 and
Statistics of Hospitalized Accident Cases, 1973, available from the Research Division.
 J 56
BRITISH COLUMBIA
Chart I—Percentage Distribution of Days of Care* by Major Diagnostic Groups, 1973
(in Descending Order)
Other
2.2%
Skin
Congenital
anomalies 1.5%
Infective and
parasitic diseases 2.5
Metabolic diseases 2.5%
MALES
Accidents
18.3%
Circulatory
system 17.6%
Nervous system    3.1
Bones
5.5%
Mental
disorders
6.49
Genito- urinary
system 6.9%
Digestive
system
Neoplasms
12.39
Respiratory
system 10.3%
8.6%
■ ■■■•■■■■■■■■■■■■■■■■■■■•■•■■■■•■■■•■•■■■■■••■•■■■■■■■■■■•■■■■IIIIIIIIIIDilliDililill
FEMALES
Other
1.7%
Skin
1.2% \
Ill-defined
conditions
1.6%   \_*
Infective and
parasitic diseases
2.2%    #'*^\.
Metabolic
diseases
2.7%
Nervous system
3.6%
Bones
6.2%
Respiratory
system
6.4%
 •
Deliveries 13.6%
/
Accidents 13.3%
Circulatory
system 12.59
Digestive system
10.8%
Neoplasms
8.8%
Genito-urinaiy
system
8.0%
•—
Mental disorders
7.4%
: Including rehabilitative care.
 HOSPITAL INSURANCE SERVICE,  1974
J 57
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 J 58 BRITISH COLUMBIA
Chart III—Percentage Distribution of Hospital Cases* by Type of Clinical Service, 1973
MALES
Adult Surgical 44.3%
Adult Medical 28.3%
Pediatric Surgical
11.1%
Pediatric Medical
10.5%
Psychiatric
4.5%
Rehabilitative Care
1.3%
llllllllllllllllllllllllllllllllllllllllltllllllllllllllllllllllllllllllllllllllilllll
FEMALES
Adult Surgical
Adult Medical 21.2%
Maternity
17.8%
Psediatric Medical
6.4%
" 'v-~ „
Psediatric Surgical
6.2%
Psychiatric
5.0%
Rehabilitative Care
0.9%
 -•
* Including rehabilitative care.
 HOSPITAL INSURANCE SERVICE,  1974 J 59
Chart IV—Percentage Distribution of Hospital Days* by Type of Clinical Service, 1973
MALES
Adult Surgical
41.6%
Adult Medical
35.9%
Pediatric Medical
7.6%
Psychiatric
5.4%
Pediatric Surgical
5.2%
Rehabilitative Care
4.3%
 ' ©
■ ■■iiiaiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiniiMiiiiii
FEMALES
Adult Surgical 40.2%
Adult Medical
29.0%
Maternity
Psychiatric
7.1%
Pasdiatric Medical
5.3%
Rehabilitative Care
3.4%
Paediatric Surgical
3.2%
* Including rehabilitative care.
 J 60 BRITISH COLUMBIA
Chart V—Average Length of Stay of Cases* in Hospitals in British Columbia, by Major
Diagnostic Groups in Descending Order, 1973 (Excluding Newborns)
Certain causes of perinatal
morbidity and mortality *4-7
Diseases of the circulatory 13 9
system
Neoplasms
Endocrine, nutritional, and
metabolic diseases
Diseases of the musculoskeletal
system and connective tissue
Congenital anomalies
Diseases of the digestive
system
Accidents, poisonings, and
violence
PROVINCIAL AVERAGE
LENGTH OF STAY
Diseases of the skin and
subcutaneous tissue
Diseases of the blood and
blood-forming organs
Diseases of the nervous
system and sense organs
Infective and parasitic
diseases
Diseases of the respiratory
system
Diseases of the genito-urinary
system
Complications of pregnancy,
childbirth, and the
puerperium
Symptoms and ill-defined
conditions
* Including rehabilitative care.
13.6
13.3
Mental disorders 131
11.9
9.5
9.2
9.0
18.9
8.9
8.4
8.4
7.3
6.4
6.3
5.1
4.8
 HOSPITAL INSURANCE SERVICE,  1974
J 61
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H
 HOSPITAL INSURANCE SERVICE, 1974 J 67
STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR THE
FISCAL YEAR ENDED MARCH 31, 1974
Administration—
Salaries 	
Temporary assistance
_      1,450,920
21,395
1,472,315
88,772
112,388
11,161
522
4,793
658
3,044
1,546
20,917
84,114
1,800,230
-_. 264,943,162
Grants in aid of equipment ...        2,779,983
Capital and debt service       7,779,199
Office expense	
Travelling expense	
Office furniture and equipment
Printing and publications	
Tabulating and rentals	
Educational material	
Motor-vehicles and accessories
Incidentals and contingencies ___
Construction and consultation _
Technical surveys and new service development
Payment to hospitals—
Claims 	
Total
277,302,574
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1975
1,030-1274-2502
 

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