The British Columbia Hospital Insurance Service plan was created by provincial legislation in 1948. It provided hospital care through mandatory payroll deductions and directly collected premiums. Unfortunately, lack of proper planning for the collection of premiums through payroll deduction and for direct payment from the enrolled, as well as inaccurate record-keeping, led to great confusion over who had paid for coverage and who had not. For example, the number of British Columbians who were seasonally employed in the fishing, lumber, mining or agricultural industries and held different jobs or were unemployed during the off-season made it difficult to collect monthly premiums and determine who was covered. For other provincial governments, the plan’s problems served as a lesson, especially in planning the financing and administration of hospital insurance, as well as in demonstrating the public’s critical response to badly administered premium collection and enrolment policies. Once the administrative and financial difficulties were resolved, the universal access to hospital care, as well as improved facilities, made the plan very popular in the province. The process of overcoming the problems encountered in instituting, administering and financing hospital coverage in British Columbia was a historic step on the road to medicare.