New Report Finds Wide Differences in Health and Health Care in North Dakota

Jun 12, 2009

Grand Forks -- The state of health and health care varies widely across North Dakota, according to a new report issued by the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences. Commissioned by Dakota Medical Foundation, the environmental scan report is the first of its kind in the state to comprehensively assess the health and health care of North Dakotans.

The message that emerges from the environmental scan is that the best of North Dakota—a cooperative and collaborative spirit, a can-do attitude, and concern for neighbors—can be brought to bear directly on transforming the state of health and health care.

North Dakota performs well on several health-related measures, including a decrease in smoking, all-time high rate of seat belt use, better-than-average hospitals and nursing homes and high-quality and efficient health care services (13th in the country).

However, the state also suffers from a large overweight and obese adult population (64.9%), the second-highest rate of binge drinking in the nation, and 8.2% of people without health insurance. Access to health services is a challenge due to geographic distances, health professions shortages, and adequate insurance coverage.

The report, An Environmental Scan of Health and Health Care: Establishing the Baselines for Positive Health Transformation, provides an overview of selected health and health care issues in North Dakota, along with measures, performances, rates and rankings. The report also features a comprehensive list of programs in North Dakota that address selected health issues.

The report compares North Dakota to benchmarks on a wide variety of topics, and notes that, because there is limited information on some topics, there is a pressing need for better data to inform community, state and tribal health policy reform efforts.

"In looking at our state as a whole, we found that, while there are areas of excellence, there are definitely areas for improvement," said co-author Boris Volkov, PhD. "We are hoping people can leverage current efforts and collaborate to share resources and ideas."

Report Highlights:

Quality of Care: The state’s health care systems perform better than many others in providing consumers with relatively high-quality and efficient health care services (the 13th highest in the country).

Environmental Challenges: The state’s growing elderly population, expanding minority population (up 13.8% from 2000 to 2006), and the significant decline in the number of youth (a 15% decline from 2000 to 2005), have direct implications for health care services. Around 12% of the state’s population lives in poverty.

Financing Health Services: Health expenditures in North Dakota increased annually by 6% from 1991 to 2004. North Dakotans spend more on hospital care, drugs and nursing home care than the overall United States.

Chronic Diseases: North Dakota’s performance on measures of chronic disease-related conditions tends to be better than national averages and most states. Cardiovascular disease and cancer are the leading causes of death in North Dakota (49% of all deaths).

Health Care Status: Public and private insurers tend to purchase health care services at low cost compared to other states. However, an imbalance between reimbursement levels and cost of providing care is driving some health care facilities to decrease services or cutback infrastructure, salaries and staffing.

Infrastructure: Supply of health workforce, aging physical plants, reimbursement levels, demographic changes and the prospect of increasing numbers of uninsured associated with deteriorating economic conditions are systemic issues facing health care facilities, both urban and rural.

Health Insurance: 8.2% (approximately 51,900 people) of North Dakotans are uninsured. Specific groups that are more likely to be uninsured include rural residents, young adults, Native Americans and workers of small employers.

Workforce: There are 271 health care provider vacancies in North Dakota for physicians, nurses, clinical laboratory scientists, mental health professionals and X-ray technicians.

Utilization of Services: The state has higher admission rates (9th highest in the nation) and longer lengths of stay than the national average (8.8 days compared to 5.7 days).

Moving Forward

The Environmental Scan report points to the need for action in key areas:

Invest in prevention-related activities;
Evaluate potential and actual decreases in service areas or closures of health facilities to determine their effect on local communities;
Close information gaps regarding chronic diseases and other common health problems;
Track access measures and viability factors to plan for minimizing access-to-care problems.
Generate a comprehensive approach to building the health workforce pipeline;
Assess insurance coverage across vulnerable groups;
Research the reasons behind utilization patterns to inform strategies to further decrease health care spending in the state;
Close information gaps regarding chronic diseases and other common health problems;
Build networks, and use telemedicine to strengthen health care services and extend these services to hard-to-reach populations; and
Promote public policy to strategically address specific problem areas, targeting resources to better meet objectives.

“The health of North Dakotans is essential to our state’s success. This environmental scan highlights areas that are at risk,” said Pat Traynor, Dakota Medical Foundation President. “By ensuring data driven decision-making, we can be more strategic with our resources to help create the healthiest state in the country.”

Visit us online to access the full report, briefs and video.

Contact: Wendy Opsahl, Communications Director, Center for Rural Health, (701) 777-0871, wopsahl@medicine.nodak.edu