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North Dakota's
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The North Dakota Department of Health is committed
to an on-going assessment of access to health care services in
North Dakota.
Rural Health Clinics (RHCs) are essential providers
of primary care for many North Dakotans.
Authorized by the Rural Health Clinic Services Act,
RHCs are located in medically underserved areas or where there
is a shortage of primary care physicians.
This Act encourages the utilization of mid-level
providers, such as nurse practitioners, physician assistants and
nurse mid-wives, to provide low-cost primary health care to underserved
areas. Federal law requires each RHC to be directed by a physician
who must visit the clinic at least once every two weeks.
The Rural Health Clinic Services Act assists rural
hospitals by helping them deliver primary
By receiving the RHC designation, a clinic can receive
cost-based reimbursement for its Medicare and Medicaid patients.
These reimbursements may be more than twice as much as a Medicaid
office visit at a non-RHC; mid-level providers are paid at the
same rate as physicians.
Almost two-thirds of North Dakota has been designated
as Health Professional Shortage Areas (HPSAs). As of Dec. 31,
1996, there were 78 designated RHCs in the state.
Information gathered from an RHC study conducted
by the health department's Health Information Systems Division
is used to determine the extent to which RHCs provide primary
care to North Dakota's rural population.
Forty-one of North Dakota's 53 counties have at least
one RHC. Of the 41counties with RHCs, 27 are frontier counties
which have fewer than six people per square mile. RHCs serve
almost 80 percent of North Dakota's frontier counties - the most
sparsely populated counties in the state.
Note: The Walhalla
Clinic closed Dec. 31, 1996. The Pembina County Memorial Hospital
in Cavalier, N.D., the entity that received RHC certification
for the Walhalla Clinic, is in the process of relocating it.
The information presented in this report does not include Walhalla
Clinic activity.
To determine North Dakotans' access to primary care
within 30 minutes of their homes, a 21-mile radius was drawn around
each clinic. When the 78 RHCs are combined with the 108 non-RHCs
that provide primary care in North Dakota, almost 97 percent of
North Dakota's population has access to care. About 94 percent
of the state's geographic area is covered. Many communities have
more than one clinic that provides primary care services; thirteen
cities have RHCs in addition to other clinics.
Note: Federal clinics,
such as U.S. Air Force clinics and Indian Health Service clinics,
were not included in this study.
Office Hour Accessibility
The majority of RHCs (58 clinics or 75 percent) are
open at least five days per week. Eleven RHCs also have weekend
office hours. Four RHCs offer evening appointments.
Office hours vary from four hours per day at 23 RHCs
to eight hours per day at 17 RHCs. The remaining clinics see
patients five to seven hours per day.
RHC Primary Care Providers
All RHCs have at least one mid-level health care
practitioner who has office hours. A physician provides oversight
to the mid-level practitioner. Most RHCs (75 clinics) also provide
physician office visits each week.
The average number of patients seen per day at RHCs
varies. More than half of the RHCs (48 clinics or 62 percent)
see 20 or fewer patients per day; yet, three RHCs see more than
75 patients per day. Based on the reported number of daily office
visits, the annual number of RHC office visits is estimated to
be between 350,000 and 520,000.
care in underserved areas. It allows them to spread
fixed costs across a larger base of patients.
Counties Served by RHCs
Coverage for Primary Care
Patient Volume
Home
Last Updated: January 23, 1997 02:51 pm
Alana Knudson - Health Information Systems Division - alknudso@state.nd.us