New Hampshire scored well in the Quality and Patient Safety Environment and in Access to Emergency Care, but a lack of medical liability reforms, growing concerns related to the availability of on-call specialists, and the loss of mental health facilities pose substantial challenges for the state.
Strengths. New Hampshire’s strong performance in the Quality and Patient Safety Environment is largely due to multiple quality control and improvement systems, including funding for quality improvement within the EMS system, required reporting of hospital-based infections, a uniform system for providing pre-arrival instructions, and a statewide trauma registry.
New Hampshire’s score for Access to Emergency Care benefits from having a high proportion of physicians accepting Medicare (4.4 per 100 beneficiaries) and a relatively low level of need for additional primary care physicians (12.4 full-time equivalents). The state also has relatively high rates of orthopedists and hand surgeons, neurosurgeons, and registered nurses, though not plastic surgeons or ear, nose, and throat specialists. New Hampshire ranks sixth for the number of Level I or II trauma centers per 1 million people. While New Hampshire has the nation’s lowest percentage of adults on Medicaid, it has lower than average rates of uninsured adults and children, as well.
The Public Health and Injury Prevention grade in New Hampshire shows mixed, though generally positive, results. The state ranks among the top 10 with regard to its relatively low rates of traffic fatalities (9.7 per 100,000 people), homicides and suicides (13.9 per 100,000), and fatal occupational injuries (21.8 per 1 million workers). The state’s infant mortality rate is lower than the national rate (5.3 versus 6.9 deaths per 1,000 live births, respectively), as is the rate of obesity among adults. Immunization rates for children and older adults are all higher than the national rates as well.
Regarding Disaster Preparedness, New Hampshire has developed an all-hazards medical response plan, which has been shared with all EMS and essential hospital personnel. There is a written plan for coordination of the State Emergency Operations Center or local emergency management agencies to provide security to hospitals during a disaster event, and the state tracks disaster preparedness funds used for health care-related preparations. The state has a real-time or near real-time syndromic surveillance system and a system for surveillance of common emergency department presentations.
Challenges. New Hampshire’s Medical Liability Environment is ranked 36th primarily due to the paucity of medical liability reforms currently in place. The state lacks a medical liability cap on non-economic damages and expert witness rules requiring case certification and that witnesses be of the same specialty as the defendant. While the state allows for periodic payments, these are permitted only at the court’s discretion. New Hampshire also suffers from an average malpractice award that is significantly higher than the average across the states ($321,011 versus $285,218, respectively).
While the state received an average grade with regard to Disaster Preparedness, New Hampshire’s infrastructure lacks patient and victim tracking systems, as well as plans to supply medications for chronic conditions and dialysis to patients during a disaster.
Recommendations. Despite having high rates of some physician specialties in relation to other states, emergency physicians in New Hampshire have reported a lack of on-call specialists of all types that has resulted in delayed care and/or patient transfers to hospitals often hours away. Policymakers should act immediately to develop a more favorable Medical Liability Environment to help recruit and retain health care providers. Specifically, instituting additional liability protections for EMTALA-mandated emergency care may encourage specialists to provide on-call services and treat higher-risk patients presenting to the emergency department.
Lack of access to mental health care also is a critical issue for New Hampshire patients. While the data reported were from the most current sources of state-by-state information, they do not reflect recent events, such as the closing of one of New Hampshire’s mental health hospitals or the closing of three mental health community centers in 2008. These occurrences, combined with a greater than average percentage of the population with an unmet need for substance abuse treatment (8.5 percent), indicate a need for further investment in services and programs for mental health care and substance abuse treatment.