North Dakota's
Rural Health Clinics

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
care in underserved areas. It allows them to spread fixed costs across a larger base of patients.

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.

Counties Served by RHCs

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.

Coverage for Primary Care

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.

Patient Volume

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.


Last Updated: January 23, 1997 02:51 pm
Alana Knudson - Health Information Systems Division -