Healthcare / Healthcare Finance

The NH Center for Public Policy Studies has been conducting research under grants from the Endowment for Health. This research focuses on public polices and private practices that affect the cost of health care, where it is provided, who gets it, and who pays for it. The ultimate goal of the project is to identify policies and practices that would maintain or enhance every resident’s ability to obtain quality health care at a reasonable price.

• Understanding the Impact of Recent Changes to NH's DSH Program (07-27-2011)

  As a coalition of New Hampshire hospitals go to court to challenge recent changes to the state's Medicaid program, here's an overview of the potential financial implications of those changes, produced by the Center at the end of the budget-writing cycle in June.

• Medicaid in NH: 2004-2007 (01-10-2008)

  Medicaid is one of the primary drivers of state expenditures across the country and in New Hampshire.   In New Hampshire, however, little long term trend analysis is available to assess the growth in the Medicaid program. This presentation, given to the House Finance Committee by Steve Norton, illistrates the Medicaid expeniture trends from 2004-2007.

• An Overview of Health Care Costs and What Are YOU Going to Do about Them? (11-01-2007)

  This is a revised version of the PowerPoint presentation that was made by Doug Hall at the November 9 "NH Health Care Summit 2005" hosted by BusinessNH Magazine in Manchester.

• An Overview of Healthcare Costs, Hospital Finances, and Cost Shifting (02-01-2006)

  This PowerPoint presentation was presented by Steve Norton to a committee of the Business and Industry Association on February 20, 2006.

• Getting What We Pay For? Health Care Spending in NH (01-22-2013)

  By many measures, health care in New Hampshire is expensive. The state spends more per person on health care, and health costs consume a greater share of the state Gross Domestic Product, than the national average of either measure. In addition, the average health insurance premium here is among the highest in the country.

  Why is that? New Hampshire does have among the best quality health care systems in the country, with strengths within the health care infrastructure. But that is not the only reason for high costs here, as other states with similar quality do not see the same spending levels as in New Hampshire.

  This paper seeks to understand the reasons behind the relatively high health care spending in New Hampshire. We also look specifically at what has driven recent increases in health care costs and spending in the state.

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• Executive Compensation at NH's Non-Profit Hospitals (07-02-2012)

  The Center examines the process and levels of compensation in recent years at the state's 23 non-profit hospital systems, with comparisons to other states in New England and an analysis of how executive compensation may relate to measures of hospital performance.

• NH's Silver Tsunami: Aging and the Health care system (09-28-2011)

   

  Aging in New Hampshire Presentation - with audio

   

  New Hampshire’s aging population will play a major role in shaping health care spending in coming decades. By the year 2020, the state’s shift towards an older population will reach a peak. And by 2030, nearly half a million Granite Staters will be over the age of 65 – a so-called “silver tsunami,” representing almost one-third of the population.

  Health care use varies by age and gender, and as New Hampshire’s demographics shift, the health care demands of the state’s population will reflect those changes. This analysis by the Center is an attempt to understand this phenomenon and help policymakers, businesses and health-care providers plan for its implications.

  At the heart of this analysis is a projection of health care spending by the major payers (Medicaid, Medicare and private insurance) that can be attributed solely to the aging of the state population. We also explore how an older population may impact the state’s workforce and the state budget. An aging population will likely place new financial pressures on Medicaid, a shift that will have a big impact on future state budgets.Many other areas of state government will also be affected by New Hampshire’s aging population and its impact on health care, including the Department of Corrections and the Department of Administrative Services.

• Health System Cost-Shifting in New Hampshire (03-13-2011)

  The Center examines the health industry practice known as "cost-shifting"–charging certain patient populations more than the actual cost of their care so as to cover the cost of providing treatment to uninsured patients or Medicare and Medicaid patients whose expenses are not completely covered by the government.

• Medicaid Procedure Fees in New Hampshire (03-16-2009)

  The Medicaid program in New Hampshire provides services to a variety of different resident populations – including lower income children and pregnant women, the elderly, and the physically and mentally disabled. Many different providers serve these Medicaid enrolled individuals, including hospitals, home health care organizations, nursing homes and physicians, among others. And these providers supply a wide array of services. In this analysis, we assess how Medicaid pays for medical, surgical, and diagnostic services by all different types of providers excluding hospital inpatient, nursing home and other institutional services. We compare Medicaid service fees to two baselines: fees paid by Medicare – the primary insurer of those over 65 and the disabled – and private payers in New Hampshire – including Anthem, Cigna and Harvard Pilgrim, among other insurers doing business in New Hampshire.

• Driving the Economy - Healthcare in New Hampshire (2008) (10-06-2008)

  The cost of personal health care is rising in New Hampshire. In the Granite State, personal health care—which includes visits to doctors, hospitalizations, medicine, and so on—consumes 18 percent of our economy, or 18 cents of every dollar. In 2007, that amounted to $10.16 billion. Twenty years ago, spending on personal health care was less than 10 percent of New Hampshire's economy. Twenty years from now, health care spending is projected to reach nearly 22 to 25 percent of economic activity.

• Driving Health Care Premiums: Cost-Shifting in New Hampshire (09-22-2008)

  In an environment in which the public payers – which account for almost 50 percent of health care expenditures – pay less than the costs of services and some of the uninsured are provided services through hospital-based charitable care, the hospital industry has to find ways to support patient care services.  One way of financing these deficits has been through allocation of unrecovered costs of one patient population to above-cost revenue collected from other patient populations – largely the privately insured.   This phenomenon is called ‘cost-shifting.’   Hospitals also generate positive operating margins. Operating margins are the share of revenues for patient care services that exceed expenses for providing that care.

• Financing New Hampshire Hospitals: Cost Shifting in 2005 (03-01-2007)

  Hospitals play a critical role in the health care system in New Hampshire. Total health expenditure in New Hampshire will total $9.65 billion in 2006.  Hospital care accounted for the largest share of personal health care spending in 2006 and will also account for the largest share of growth over the next five years. Understanding hospital finances is critical to understanding the broader health care market and the future of the health care safety net, as the hospital sector is an important asset for the state and for the communities in which the hospitals reside.

• Health Care Coverage in New Hampshire: Estimates of Proposed Expansions (03-01-2007)

  This paper simulates the impact of LSR 886 to provide information to policy makers reviewing the various initiatives to expand coverage. For a variety of reasons discussed below, we estimate the impact in three parts: the proposed change in the private market, an expansion to those 19-20 year olds with income less than 300% of the federal poverty level (FPL) – the equivalent of $49,800 for a family of three – and an expansion to those 19-25 year olds with incomes less than 500% of the FPL.[2] Table 1 below documents the results of the simulation, showing the impact of the proposed policy changes on the number of uninsured and state and federal costs.

• 16 Cents of Every Dollar: Health Care Costs in New Hampshire (03-01-2007)

  This paper is the latest in a series the Center has published on health care finance and insuring the New Hampshire workforce.The cost of personal health care is rising in New Hampshire, as it is across the nation. In the Granite state, personal health care—which includes visits to doctors, hospitalizations, medicine, and so on—consumes 16% of our economy, or 16 cents of every dollar. In 2006, that amounted to $9.65 billion.

• Selected State and National Websites with Information on Quality of Care and/or Health Care Prices (02-01-2007)

  This page contains links to websites that are discussed in an upcoming report, "How Are Other States Providing Health Care Information to Policymakers, Patients, and the Public?" We expect to release the report by the end of March, but have posted these links now so that interested participants in the Citizens' Health Initiative can easily peruse these sites themselves. The states are California, Maine, Massachusetts, Minnesota, New York, Utah, Vermont, and New Hampshire.

• How are Other States Providing Healthcare Information to Policymakers, Patients, and the Public (04-01-2006)

  This report focuses on information on health prices, costs, and quality. The paper’s primary objective is to provide information on other states’ efforts that New Hampshire could adopt in order to expand the amount of useful healthcare information available to the New Hampshire’s policymakers, patients and the public. In addition to New Hampshire, the states that are explored are California, Maine, Massachusetts, Minnesota, New York, Utah and Vermont. The report includes a list of websites for each of the selected states.

• Peeling the Onion: Inpatient Hospital Care in New Hampshire (02-01-2006)

  This report identifies the primary trends within the hospital inpatient market for 2001-2003. The primary finding is that cost-containment strategies focusing on the elderly and the Medicare enrolled population, those accounting for the lion’s share of inpatient utilization, are most likely to be effective at controlling growth in this sector of the health care market.

• Searching for Useful Health Care Prices (01-01-2006)

  This report anticipates changes that will occur if responsibility for paying for health care is further shifted onto individuals in the future. It identifies the kind of information consumers will need to make personal health care purchasing decisions. It presents the necessity of having actual prices (not just charges) available so consumers can make intelligent choicest. It presents sources of price and quality information that are currently being designed and built for future use in the New Hampshire health care marketplace.

• Basic Facts on Health Insurers in NH, 2001-2004 (10-01-2005)

  This report is an update to "Commercial Health Insurers: Intermediaries in Health Care Finance," issued by the Center in October 2004. It presents basic data on the largest companies selling health insurance in the state in 2004 as submitted to the NH Insurance Department. The insurance covered 372,390 lives and the companies were paid over $1.2 billion for this coverage.

• State Level Options for Reducing Private Sector Health Care Costs (10-01-2005)

  This paper lists eleven ideas for ways to reduce health care costs without simply shifting the cost onto others or reducing access to care or quality of care. Some of the ideas have been debated with regularity, others are offered for a first discussion in the state.

• Health Care Dollars and Health Insurance in New Hampshire, 2004 (09-01-2005)

  This report presents basic data about the total costs of the health care system in New Hampshire in 2004. We estimate that the cost of personal health care spending in 2005 will amount to $7.5 billion. The report also presents data on the cost of health insurance and its availability to employees. 69% of full time workers in New Hampshire are enrolled in a health insurance plan while only 10% of part time employees are so enrolled. Other details are presented in the report.