NH's Healthcare System / 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.

• Goals or Principles of Health Care Reform (11-01-2004)

  This is one of 10 issue briefs that were prepared for the Endowment for Health's Citizens Roundtable. It reviews different goals for health care reform that have been suggested by different organizations and attributes the differences in goals to differences in the relative weight each organization gives to underlying values.

• Health Care Access, Cost, and Quality (What We Don't Know Can Hurt Us) (10-01-2004)

  These PowerPoint slides were part of a presentation at the meeting of the New Hampshire Public Health Association in Plymouth, NH, on October 29, 2004. They present information about the health care system in New Hampshire and the information that is needs to understand the system better and to ultimately suggest reform policies that might better control costs and increase access to care while not adversely affecting the quality of that care.

• Cost-Shifting in New Hampshire Hospitals, 2004 (02-01-2006)

  This report finds that the costs of freely provided charity care, bad debt, and underpayments by Medicare and Medicaid resulted in $300 million of cost-shifting by the state's 26 community hospitals in 2004. Health insurers paid, on average, 138% of cost for hospital services to fund the cost-shift and hospital margins that averaged 5.9%. The report, an update to our report of October 2003, presents a cost-shift "Hydraulics diagram" for each hospital for the first time.

• The Third Safety Net (08-01-2005)

  This report notes that health care providers are losing revenue due to free care, bad debt, and payments from public programs that are less than the cost of the services provided. It warns that some providers may soon begin to claim the right to payment for these services from town and city governments under an old law, RSA-165. The report includes examples of towns having paid for such services for their indigent residents in the 19th and 20th centuries under that law.

• A Framework for Thinking About Cost-Shifting in Health Care (11-01-2004)

  This is one of 10 issue briefs that were prepared for the Endowment for Health's Citizens Roundtable. It explains cost-shifting using a special graphic to make the effect more easily understood. It also discusses the effect of different changes in environment and policy on cost-shifting by simple examples.

• The Financing of New Hampshire's Health Care System (11-01-2004)

  This is one of 10 issue briefs that were prepared for the Endowment for Health's Citizens Roundtable. It describes the total cost of the personal health care system in New Hampshire, the major components of cost, and the sources of funds that pay those costs. It includes a projection of costs to 2010.

• Who Are the Uninsured in New Hampshire? (11-01-2004)

  This is one of 10 issue briefs that were prepared for the Endowment for Health's Citizens Roundtable. Using data from surveys, it estimates that 120,000 NH residents were uninsured on any given day in 2003. It compares the rate of uninsured in our state to the other states and identifies some characteristics of the uninsured in our state.

• Quality of Health Care (11-01-2004)

  This is one of 10 issue briefs that were prepared for the Endowment for Health's Citizens Roundtable. It describes the data available regarding quality of care in NH, notes that there is evidence that the quality is quite good, cites a survey that shows residents are more concerned about cost than quality, and proposes some policies that might improve access to information about quality of care.

• Health Care and Market Competition (11-01-2004)

  This is one of 10 issue briefs that were prepared for the Endowment for Health's Citizens Roundtable. It investigates the degree to which a market is operating in New Hampshire for the purchase of hospital services or health insurance. It points out ways in which health care markets are currently different from pure markets.

• Will the Real Healthcare Cost Drivers Please Stand Up? (11-01-2004)

  This is one of 10 issue briefs that were prepared for the Endowment for Health's Citizens Roundtable. It summarizes many factors that have been identified as underlying causes for the rapid rise in health care costs in recent years. It also points out that some factors are simultaneously the cause and effect of changes to other factors, making clear identification of cost-drivers very difficult.

• Commercial Health Insurers: Intermediaries in Health Care Finance (11-01-2004)

  This is one of 10 issue briefs that were prepared for the Endowment for Health's Citizens Roundtable. It summarizes basic financial information submitted by the five primary health insurers in the New Hampshire market regarding the health care claims paid and administrative costs.

• The Planned Comprehensive Health Care Information System: An Opportunity to Better Understand Cost and Quality of Health Care in NH (11-01-2004)

  This is one of 10 issue briefs that were prepared for the Endowment for Health's Citizens Roundtable. It reviews the status of the uniform health care claims database that was authorized by the New Hampshire legislature in 2003. It discusses the rules related to release of the data that will be collected and the need for operating funds and analytic capability necessary to make proposed the new information resource a reality.

• Cost-Shifting in New Hampshire Hospitals (10-01-2003)

  This report investigates the finances of New Hampshire's 26 acute care hospitals in 2001. It finds that Medicare reimbursement of hospitals was inadequate by $119 million and Medicaid by $30 million. In addition, hospitals provided $86 million in unpaid charity care and bad debt. To attempt to balance their books, hospitals were are to collect an excess of $134 million from insurance companies and $64 million directly from patients that they used to pay for the care that was otherwise inadequately reimbursed. Payment of claims by insurance companies included an average 17% hidden tax to pay for the costs of Medicare and Medicaid patients and those individuals who could not pay their full charges. The report concludes that more information on actual charges, costs, and payments should be made available to the public.

• Options for Expanding Health Insurance Coverage in New Hampshire (10-01-2003)

  This paper is a discussion draft that we intend to update and expand upon through the end of 2004. It lists and describes 29 different policies grouped into six categories: universal coverage, expansions of SCHIP & Medicaid, other subsidies and tax credits, mandate options, insurance reforms, and other. We seek feedback on this inventory of possible policy options from readers.

• Factors that Affect the Percentage of the NH Population without Health Insurance (10-01-2003)

  This report investigates the relation between the proportion of a state's population that lacks health insurance and other economic and demographic factors. It concludes that New Hampshire's low "rate of uninsurance" is largely the result of our state's low unemployment, low numbers of recent immigrants from other countries, and large percentage of the labor force employed in manufacturing. It concludes that the uncertain economy and state budget pressures are likely to increase the percentage of the population without health insurance over the next few years, in the absence of major federal or state policy changes.

• Measured Care: Bar Codes Enable a Detailed Analysis of Services Provided to (05-01-2003)

  This report investigates the types and numbers of services provided to seniors in assisted living facilities (ALFs). One finding is that residents receive far more professional care—from registered nurses, in particular—during the beginning of their stay in an ALF than in the months that follow. Another is that single largest consumer of staff time was simply reminding residents to take their medications. The data was collected using optical scanner and bar codes. The ALF staff used scanners to record every interaction with every resident in their facilities for a full year, more than 800,000 in total. This technology might also be applied to advantage in other service delivery settings.

• Over-Prescribed: Many NH High Schools Require Too Many Physicals for Student Athletes (08-01-2002)

  This paper investigates the evidence for and patterns of requirements for pre-participation sport physical exams for high school athletes. It finds that many New Hampshire schools require more exams than medical evidence indicates are necessary. Eliminating those unwarranted examinations could save the families of New Hampshire’s student athletes somewhere between $160,000 and $800,000 per year in medical costs: a savings of roughly 50 to 75 percent over the course of a high-school student’s sports career.