North Dakota continues its solid performance, ranking eighth in the nation overall, improving with regard to Disaster Preparedness and its Medical Liability Environment. However, problems have worsened in Public Health and Injury Prevention, requiring that effective actions be taken to improve public health and safety.
North Dakota continued to excel in Disaster Preparedness. The state has a budget line item for Disaster Preparedness funding specific to health care surge (one of 11 states to do so), as well as a patient-tracking system and a statewide medical communication system with one layer of redundancy. The state also has systems in place to address behavioral health concerns during a disaster, having incorporated mental health patients and patients dependent on psychotropic medications in its medical response plan and instituting mutual aid agreements with behavioral health providers to provide services during an event. The state also has the fifth highest number of behavioral health professionals registered in the Emergency System for Advance Registration for Volunteer Health Professionals (52.9 per 1 million people).
North Dakota's Medical Liability Environment has improved since 2009, primarily due to decreases in medical liability insurance premiums and an increase in the number of insurers writing policies. The average medical liability premiums for specialists is $25,510 (the fifth lowest in the nation) compared to $35,922 in the 2009 Report Card. North Dakota has maintained its medical liability cap on non-economic damages and has abolished joint and several liability.
North Dakota's grade in Access to Emergency Care reflects a mixture of positive and negative results. The state ranks among the top 10 with regard to health insurance for adults and children and has the lowest proportion of underinsured adults (4.6%). It has the fourth highest proportion of underinsured children, however, with 21.7% of parents of children with insurance reporting that their out-of-pocket costs were not reasonable. The state fares excellently regarding hospital capacity, with 514.3 staffed inpatient beds per 100,000 people and 37.2 emergency departments (ED) per 1 million people. ED wait times are third best in the nation, averaging 189 minutes from ED arrival to ED departure for admitted patients.
A few factors contributed to North Dakota's poor grade in regard to the Quality and Patient Safety Environment. The state lacks funding for both an emergency medical services (EMS) medical director and quality improvement of the EMS system. Additionally, North Dakota's hospitals are among the least likely to collect data on patients' race and ethnicity and primary language (28%), or have a diversity strategy or plan (18%).
North Dakota continues to falter with regard to Public Health and Injury Prevention. While the state has one of the lowest combined rates of homicides and suicides, it has the third highest rate of fatal occupational injuries (94.0 per 1 million workers) and 10th highest rate of fall-related deaths (12.3 per 100,000 people) in the nation. In addition, the state has only secondary enforcement of adult seatbelt laws applying to front seat occupants, despite having the fourth lowest proportion of front-seat occupants using seatbelts (76.7%). Nearly a quarter of adults in North Dakota binge-drink (23.8%), for which they rank third worst in the nation, and 45% of traffic fatalities are alcohol-related (rank: 47th).
North Dakota should take action to improve the public health and safety of its people. One way to do so would be to consider legislation aimed at reducing traffic fatalities, which are much higher than the national average (14.2 versus 9.0 per 100,000 people), including requiring helmets for all motorcycle riders, strengthening adult seatbelt laws through primary enforcement and requiring that seatbelts be used in all seats, and instituting an intermediate driver's license stage with nighttime driving restrictions and supervised practice driving hours. Additional health promotion efforts should be aimed at reducing cigarette smoking and binge drinking, the latter of which may contribute to the state's high rate of traffic fatalities that are alcohol-related.
North Dakota could also help to improve its Quality and Patient Safety Environment by funding an EMS medical director and encouraging hospitals to collect data on patients' race and ethnicity and primary language. This may be a first step in helping to address the relatively high cardiovascular disease and infant mortality disparity ratios in the state.