New Hampshire continues to improve its Quality and Patient Safety Environment and Disaster Preparedness efforts, but a stagnant Medical Liability Environment and growing concerns about emergency department (ED) boarding and crowding, due to inadequate resources, contribute to the state's overall decline from 15th to 28th place.
New Hampshire has instituted many policies and practices to contribute to its overall Quality and Patient Safety Environment, including having triage and destination policies in place for stroke, ST-elevation myocardial infarction (STEMI), and trauma patients, and working toward developing and implementing a statewide trauma registry. It has the highest rate of hospitals with a diversity strategy or plan (62.5%) and the fifth highest rate of hospitals collecting data on patient race and ethnicity and primary language (78.1%).
New Hampshire has dramatically improved its ranking in Disaster Preparedness since 2009, partly from implementing a statewide patient-tracking system, significantly increasing volunteer registration in the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP), and having in place statewide mutual aid agreements with behavioral health providers to provide care to patients during an event. The state also has just-in-time training systems in place to notify and train health care workers in case of a disaster and maintains a statewide medical communication system.
New Hampshire is facing a psychiatric care crisis, which has affected emergency care throughout the state. Availability of psychiatric care beds (22.9 per 100,000) and staffed inpatient beds (251.6 per 100,000) has further declined since the 2009 Report Card. Boarding of mental health patients in the ED has likely contributed to New Hampshire's higher-than-average median time from ED arrival to ED departure for admitted patients (298 minutes). Additionally, the state has a relatively high proportion of adults needing but not receiving substance abuse treatment (9.6%).
While New Hampshire continues to have among the highest rates of health insurance coverage for adults and children, financial barriers that may result in declining or delaying needed care are still reported. In all, 8.5% of adults and 19.5% of children are underinsured. Medicaid fees for physician office visits have remained stagnant from 2007 to 2012, resulting in New Hampshire having fee levels that are only 81.1% of the national average.
New Hampshire's Public Health and Injury Prevention grade is affected greatly by its failure to pass traffic safety legislation. The state lacks laws requiring helmets for motorcycle riders, requiring adults to wear seatbelts, prohibiting cell phone use while driving, and requiring strict graduated driver licenses aimed at increasing the safety of teen drivers. New Hampshire has the third lowest rate of front occupant seatbelt use in the nation (75.0%). Also contributing to New Hampshire's score are relatively high disparity ratios related to cardiovascular disease prevalence and HIV diagnoses.
New Hampshire continues to have among the worst Medical Liability Environments in the nation. The state has failed to enact case certification requirements or pass expert witness rules requiring witnesses to be of the same specialty as the defendant and licensed to practice medicine in the state. While periodic payments are permitted, they are not required and are at the court's discretion. Medical liability caps on non-economic damages and collateral source rule reform were declared unconstitutional in 1980, and no changes have been made since that time. The state also lacks additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act.
New Hampshire must act immediately to address its underresourced mental health system, work with hospitals throughout the state to increase the number of available psychiatric and staffed inpatient beds, and reduce boarding and crowding in EDs. The state must invest in community services and programs for mental health care and substance abuse treatment to alleviate these issues and to ensure a safe and effective system of care.
To improve traffic safety, New Hampshire should consider passing legislation to require helmet use for motorcycle riders as well as a universal seatbelt law with primary enforcement. To reduce the burden of disease, the state should seek to reduce racial and ethnic health disparities in cardiovascular disease and HIV risk.
New Hampshire should continue to support the Quality and Patient Safety Environment by maintaining funding for quality improvement within the emergency medical services system and developing a prescription drug-monitoring program, legislatively enacted in 2012, that monitors drug schedules II through V and provides real-time data collection from providers.