1. LITERATURE SEARCH
Effect of Boom Growth on Healthcare Utilization
………………………………………………………………………………………………………………………………………
04 April 2013
QUESTION
Want to explore the effect of oil booms/air force base growth on healthcare utilization
RESULTS
The recent oil boom in the Dakotas and Texas over the past two years has deluged small rural towns with
workers and their families. Area infrastructures are strained beyond limit in housing, roadways, schools, and
healthcare. The healthcare landscape has shifted from elderly Medicare patients to young families and
singles, many uninsured. Ironically, these states continue to fight against Obamacare. Hospital bad debt has
soared to unsustainable levels as bills for emergency treatment are returned to the hospital “addressee not
found”. Hospitals are having more than the usual problem of recruiting to rural areas due to the lack of
adequate housing and community infrastructure.
Healthcare utilization is largely:
● Trauma patients, from road and worksite accidents
● An increased need for orthopedic surgery to repair broken bones
● Sexually transmitted diseases
● Pediatric needs
● Occupational therapy
● Mental health
● Routine care for those with chronic conditions
See news stories on the impact of the Dakotas and Texas oil booms from 2011 to present
Depending on location and resources, most military personnel and their families receive care at the
hospital/clinic on the Air Base. TRICARE is military health insurance which is available in varying plans.
Increasingly, civilian providers are accepting TRICARE patients.
See available data on Air Force Base growth. Impact of bases is discussed in terms of economic stimulation
but a suggestion of their utilization of civilian facilities can be suggested from the number of providers
accepting military insurance.

2. Oil Boom
An Oil Boom Takes a Toll on Health Care
New York Times. January 27, 2013
The patients come with burns from hot water, with hands and fingers crushed by steel tongs, with
injuries from chains that have whipsawed them off their feet. Ambulances carry mangled, bloodied
bodies from accidents on roads packed with trucks and heavy­footed
drivers.
The furious pace of oil exploration that has made North Dakota one of the healthiest economies in
the country has had the opposite effect on the region’s health care providers. Swamped by
uninsured laborers flocking to dangerous jobs, medical facilities in the area are sinking under
skyrocketing debt, a flood of gruesome injuries and bloated business costs from the inflated
economy.
● Largely because of unpaid bills, the hospital’s debt has climbed more than 2,000 percent
over the past four years to $1.2 million
● One hospital averaged 400 emergency department visits a month in 2012
● Over all, ambulance calls in the region increased by about 59 percent from 2006 to 2011
● The number of traumatic injuries reported in the oil patch increased 200 percent from 2007
through the first half of last year
● Expenses at those 12 facilities increased by 15 percent . . . [9] experienced operating
losses
● Costs are rising to hire and retain service staff members, as hospitals compete with fast
food restaurants that pay wages of about $20 an hour
Oil boom leads to surging ER visits, wait times, STDs
CNNMoney.com. November 7, 2011
Mercy Medical Center, the only hospital in Williston, N.D., had to double the number of seats in its
waiting room six weeks ago.
It also had to hire security guards to ensure the safety of incoming patients this year, a precaution
that has become necessary: emergency room visits have increased 50% in the last 12 months and
wait times now average at least a couple hours.
● on any given day, there are 30% more requests for medical services than it can accept.
● So many workers come in with injured ­­or
missing ­­toes,
fingers and other appendages
that orthopedic extremity surgeries have tripled within the last year
● Because of all the new patients, the average wait time is now at least two hours (and often
more than three hours), up from less than an hour a year ago

3. N.D. OIL PATCH: Health care industry feels strain of oil boom
GrandForksHerald. November 12, 2011
● Mercy Medical Center is dealing with a baby boom and a sharp increase in medical
emergencies and clinic visits resulting from the area’s oil boom.
● Trinity Health in Minot has seen its emergency department caseload double in six years, to
40,000 visits a year. We see a pretty heavy shift to trauma.”
● Trauma cases run the gamut: burns, falls, explosions, chemical inhalations, crushing
injuries, traffic accidents. It’s not uncommon for Trinity’s helicopter air ambulance to make
three or four runs a day, Sather said.
● Also, three of every four burn transfers from North Dakota to Minneapolis are transports
from Trinity, Sather said.
● Combined, urgent care and emergency room visits have doubled in the past three years
Oil Boom Crunches Rural Medical Facilities
Daily Yonder. October 17, 2012
. . . An older population (eligible for Medicare) is declining, as a younger population, many of them
uninsured, is rapidly expanding. There's major overload on emergency facilities, accompanied by
skyrocketing bad debt. Nurse and staff recruitments have become much more difficult due to high
housing prices and high competitive wages in the oil patch. And attracting physicians, always a
problem for rural areas, has gotten tougher, even as needs soar.
“In 2007 we would see 600 patients in ER per year,” Pederson says. “In 2012, we anticipate seeing
over 2,000.” That means in a five­year
period, Tioga’s emergency room visits have more than
tripled.
“We are seeing a lot more industrial accidents, major trauma, many of those involving car accidents,
because there’s a lot more vehicles on the roads these days,”
Dr. Tyrone Langager at the Montrail County Medical Center in Stanley says the emergency room
load there is four to five times what it was a few years ago. In Watford City, a town whose
population has grown from 1,500 to 6,000 in 18 months, McKenzie County Hospital CEO Dan Kelly
says his ER load has doubled in a year.
At the larger Mercy Hospital in Williston, CEO Matt Grimshaw says the emergency room in
pre­boom
times saw 8,000 visits in a normal year. For 2013, he says the staff expects that number
to more than triple. Echoing Randall Pederson in Tioga, Grimshaw says the current kinds of ER
injuries are different. Mercy has seen a doubling of traumatic orthopedic injuries in the last couple of
years, from both oil field and highway accidents.

4. General
Economic Impacts of the Military Bases in Washington
Office of Financial Management. State of Washington. July 2004.
Tricare payments to health care providers in Washington . . . range from $31.1 million per year in
Pierce County to $3.8 million in Yakima County. The statewide total is $116 million.
The Impact of the Recommendation to Close Ellsworth AFB
The NewsHour with Jim Lehrer. August 12 2005
Rapid City Regional Hospital {SD}, the loss of patients would be significant. In the past five years,
military personnel and their dependents have generated $50 million in hospital bills.
States Show Increase in TRICARE Providers
Tricare. 06/10/2011
Today, more than 325,000 providers across the United States are in the TRICARE network, with
over 1 million providers accepting TRICARE beneficiaries. The Department of Defense (DoD)
Survey of Civilian Physician Acceptance of TRICARE Standard shows that in Fiscal Year 2007,
almost 93 percent of responding physicians in 53 areas were aware of the TRICARE program.
Almost 85 percent of those physicians accepted new TRICARE Standard patients.
The campaign to increase the number of providers accepting TRICARE patients started several
years ago, led by the TRICARE Regional Office­West
and TriWest Healthcare Alliance, the
TRICARE managed care support contractor serving 21 western states.
Recently, Colorado’s leadership announced the number of providers in the state increased from
4,830 to more than 7,920. Hawaii’s leadership announced the number of providers in the state
increased from 2,885 to close to 4,000. At the same time, Idaho’s number of providers in the state
increased from 2,190 to more than 3,820 and Utah’s number of providers increased from 2,200 to
more than 3,600. The most impressive numbers thus far come from South Dakota, where the
number of providers in the state increased from 900 to more than 3,000.
Grand Forks Air Force Base, North Dakota
● Routine and acute care are provided to active duty personnel
● Anyone not enrolled in TRICARE Prime must utilize civilian healthcare resources in surrounding
cities
● Dental care is reserved for active duty; all others must use civilian resources
● There is no emergency facility on the base. Patients are referred to Altru Hospital in Grand Forks.
Signs of growth:
Drones Increase Grand Forks Air Force Base's Economic Impact
March 2, 2013. The Dickinson Press
The base released its annual economic impact report this week, which showed a total impact of
$203.1 million, up $13.8 million, or 7 percent, from the previous fiscal year. . . . In September 2011,

5. we had roughly 1,200 military members assigned at Grand Forks,” said base spokesman Tim Flack.
“Now, we have more than 1,500 stationed here.”
Minot Air Force Base, North Dakota
Hospital offers a full complement of services to active duty personnel and their dependents. Patients are
also referred to Sanford Health Walk­In
Clinic, Trinity Medical Arts Clinic, and the St Alexius Medical Center
in Fargo apparently for weekend, after hours, and holiday care.
Signs of growth
MAFB Impact Growing
Minot Daily News. February 11, 2013
Minot Air Force Base added $522.6 million into the local economy in fiscal year 2012, the largest
economic impact in the base's history. Healthcare impact not stated