North Dakota is one of the most rural states in the country. Yet, it ranks high on scorecards measuring access, quality, utilization, equity and health outcome. What’s their secret?

It’s partly because of the doctors’ eagerness to collaborate, which is often borne from necessity:

“In North Dakota, our health care facilities are not so rich that they can afford to pursue new initiatives without thinking first of knocking on the door of a neighbor and asking for help,” said Dr. Wakefield.

With a limited and small patient population and fixed overhead, the rural hospitals are very interested in ways to share costs and increase profitability.

Can depriving physicians of money and staff force cooperation, which in turn subsequently improve health outcomes? It sounds like we’re headed in that direction if the politicians get their way.