The Health Promotion and Disease Prevention Policy Team of the New Hampshire Citizens Health Initiative has released its first report on health care in New Hampshire, “A Pound of Prevention.” This report utilizes the most current data available in 2006. The Citizens Health Initiative is a long term, broad-based coalition that brings together private citizens, businesses, medical providers, and community agencies to improve the health of New Hampshire’s citizens. The initiative has three major goals, each with a working group assigned to it:
Promoting improved health and disease prevention
Improving the quality of health care
Promoting openness of information
This paper addresses the first goal – promoting improved health and disease prevention.
While New Hampshire is relatively healthy, not all the state’s citizens are equally healthy. Additionally, we are living longer. NH has the same health challenges and leading causes of death as the rest of the United States.
Many diseases are preventable which is why the policy team has recommended a focus on tobacco and alcohol, improved nutrition and physical activity, awareness of environmental influences, injury prevention and mental health services.
The members of the Citizens Roundtable were called together by the Endowment for Health to look at the many challenges facing the health care system and make recommendations that would strengthen the health care system in New Hampshire.
Recommendations were made in several key areas including:
Working together to keep the health care system stable;
Ensuring that information is available to understand and make important decisions about our health care system;
Understanding how well the health care system is working for NH’s citizens.
A new dynamic is at work in the health care system, brought on by a decline in employer-based coverage and a sustained increase in health care costs. We believe that together these forces create potentially destructive pressures on the system and may cause instability and the loss of providers essential to our community’s health.
In September 2004, the Endowment for Health charged the Citizens Roundtable to:
Develop a common understanding of the causes and impacts of rising health care costs, expenditures, and insurance premiums, and Recommend actions to New Hampshire policy-makers (potentially with federal partners), employers, health care providers, and the general public that could meaningfully address rising costs, access, and quality.
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 $10.6 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.
Perhaps most striking in this analysis is the degree to which healthcare plays an even larger role in the economic landscape in New Hampshire. Hospitals are often the single largest employer in the labor market areas across New Hampshire. More generally, the health and social services industries account for a significant share of economic activity -- as measured by wages -- particularly in rural areas of the state.
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.
The high cost of health insurance is a financial burden for small businesses. This brief outlines the results of a recent poll of NH small business owners, the majority of whom say they want and need health care reform.
The 2009 update to our popular healthcare policy tool, challenging the perception that NH is one of the healthiest states in the nation.
According to Executive Director Steve Norton, New Hampshire’s overall average dashboard score is 78.2%, which places the Granite State at twenty percent of the best ranked states. “New Hampshire’s dashboard score is helped considerably by favorable average score values on quality (98.6%). New Hampshire’s overall score is hindered by poorer score values on infrastructure (69.0%), access (72.9%) and cost (74.5%),” said Norton.
New Hampshire’s quality indicators demonstrate a high level of care. However, New Hampshire’s healthcare is expensive, causing New Hampshire to receive a less favorable score on that indicator.
As an example of the potential for healthcare cost reduction within the New Hampshire system, the Center used the Dashboard methodology to compare the Granite State to the top “low cost, high quality” states. The best states for low cost and high quality are South Dakota, Hawaii, Utah, Colorado, and Virginia.
“If New Hampshire had healthcare costs equivalent to the top ‘low cost, high quality’ states, New Hampshire healthcare costs, (currently about $10 billion per year), would shrink by $2 billion,” said Norton.
“These results should be a source of concern for policy makers, as they suggest that the state’s relatively high cost of healthcare and high quality care is not necessarily translating into a healthy population, or one with high access to care.,” according to Norton. “It is important to monitor the entire healthcare system in New Hampshire. The Dashboard provides an effective way of judging the progress New Hampshire is making in improving the health of our citizens.”
More than one in ten New Hampshire households experience food insecurity, and there is considerable variation across the counties in the state. Food insecurity is significantly related to both household income and the distance a household must travel to shop for groceries. Limited access to quality, affordable groceries makes it hard for families to provide sufficient nutritious food, which has been linked to poor diet and obesity as well as greater risk for chronic disease, such as diabetes and heart disease. This mapping project and study bears out the national research and illustrates the dynamic of "food deserts" in New Hampshire as well as their impact on the health of our people.
This paper introduces the findings of a new healthcare dashboard designed to assess different aspects of the performance of the healthcare system in New Hampshire. In collaboration with a workgroup of participants in the Citizen's Health Initiative, the Center developed a set of indicators designed to assess and monitor key dimensions of the healthcare system in New Hampshire. The key dimensions are cost, the healthcare infrastructure, access to services, the quality of care and the public's money.
A growing segment of New Hampshire's population lacks health insurance. Using 2001 as its benchmark of 100.0, in the third quarter of 2007, the Center's "Index of the Population Lacking Health Insurance" registered 117.7. This means the number of uninsured persons in New Hampshire has potentially risen above 130,000.
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.