New Hampshire

Category Grades
15C+ 28D+
Access to Emergency Care:
11B- 30D-
Quality/Patient Safety:
14B+ 10B
Medical Liability:
36D- 41D-
Public Health/ Injury Prevention:
20C+ 32D+
Disaster Preparedness:
32C 12C+

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.

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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.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 9.8 10.2
Emergency physicians per 100,000 pop 11.9 13.9
Neurosurgeons per 100,000 pop 2.1 2.1
Orthopedists and hand surgeon specialists per 100,000 pop 10.9 13.3
Plastic surgeons per 100,000 pop 1.8 2.3
ENT specialists per 100,000 pop 3.1 3.3
Registered nurses per 100,000 pop 970.4 1,051
Percent of children able to see provider 98.1
Level I or II trauma centers per 1M pop 3.8 1.5
Percent of population within 60 minutes of Level I or II trauma center 81.7 96.2
Accredited chest pain centers per 1M pop 0 1.5
Percent of population with an unmet need for substance abuse treatment 8.5 9.6
Pediatric specialty centers per 1M pop 3.8 2.3
Medicaid fee levels for office visits as a percent of the national average 99.6 81.1
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 12 0
Percent of adults with no health insurance 12.7 13.9
Percent of adults underinsured 8.5
Percent of children with no health insurance 7.5 7.4
Percent of children underinsured 19.5
Percent of adults with Medicaid 3.3 3.6
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 257.4 251.6
Hospital occupancy rate per 100 staffed beds 66.2 64.6
Psychiatric care beds per 100,000 pop 34.5 22.9
Median time from ED arrival to ED departure for admitted ED patients 298
State collects data on diversion YES NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $11.71 $9.90
State budget line item health care surge YES
ESF-8 plan is shared with all EMS and essential hospital personnel YES YES
Emergency physician input into the state planning process NR NO
Public health and emergency physician input during an ESF-8 response YES
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) NO NO
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan NO NO
Medical response plan for supplying dialysis NO NO
Mental health patients included in medical response plan NO
Medical response plan for supplying psychotropic medications NO
Mutual aid agreements in place with behavioral health providers STATE LEVEL
State requires long-term care and nursing home facilities to have a written disaster plan YES
State able to report number of exercises involving long-term care facilities or nursing NO
Just-in-time training systems in place STATEWIDE STATEWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system NO YES
Statewide real-time or near real-time syndromic surveillance system YES YES
Real-time surveillance system in place for common ED presentations YES YES, STATEWIDE
Bed surge capacity per 1M pop 657.4 650.4
ICU beds per 1M pop 314.1 273.3
Burn unit beds per 1M pop 0 0
Verified burn centers per 1M pop 0 0
Physicians registered in ESAR-VHP per 1M pop 0.8 22
Nurses registered in ESAR-VHP per 1M pop 91.2 312.7
Behavioral health professionals registered in ESAR-VHP per 1M pop 16.7
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel NO, NO NO
Percent of RNs that received emergency training 38.1 38.5

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 13.6 15.5
Lawyers per physician 0.5 0.5
Lawyers per emergency physician 11.3 11.2
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 3.5 2.7
Average malpractice award payments $321,011 $321,721
National Practitioner Databank reports per 1,000 physicians 16 31.2
Apology laws: Apology is inadmissible as evidence in a court of law YES
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 12.9 15.1
Average medical liability insurance premiums for primary care physicians $13,120 $12,552
Average medical liability insurance premiums for specialists $56,055 $59,678
Presence of pretrial screening panels MANDATORY MANDATORY
Pretrial screening panel's findings admissible as evidence NO NO
Periodic payments are: required, granted upon request, at court's discretion AT JUDGE'S OR COURT'S DESCRETION AT COURT'S DESCRETION
Medical liability cap on non-economic damages NONE NONE
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished YES YES
Collateral Source Rule/Provides for Awards to be Offset NO
State provides for case certification NO NO
Expert witness required to be of the same specialty as the defendant NO NO
Expert witness must be licensed to practice medicine in the state NO NO

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists 4.3
Pedestrian fatalities per 100,000 pedestrians 2.2
Percent of traffic fatalities alcohol-related 41 32
Percent of front occupants using restraints 63.8 75
Child safety seat/seat belt legislation - score out of a possible 10 points 1 2
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 2
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 81.5 75.4
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 71.9 57.4
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 68.4 73.1
Fatal occupational injuries per 1M workers 21.8 9.9
Homicides and suicides (non-motor vehicle)(per 100,000) 13.9 15.1
Unintentional fall-related fatal injuries (per 100,000) 8.2 11.8
Fire/burn related fatal injuries (per 100,000) 1 1
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.2 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 9.3
Total injury prevention funds per 1,000 persons $317.67 $304.58
Dedicated child injury prevention funding NO
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 1
Infant mortality rate per 1,000 live births 5.3 4
Percentage of adults who binge drink 15.2 18.7
Percentage of adults who currently smoke 18.7 19.4
Percentage of adult population who are obese (BMI > 30.0) 22.4 26.2
Percentage of children who are obese 15.5
Cardiovascular disease disparity ratio 2.9
HIV diagnosis disparity ratio 16.9
Infant mortality disparity ratio NR

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES YES
Funded state EMS medical director NO NO
Emergency medicine residents per 1M pop 0 4.5
Adverse event reporting required NO YES
% of counties with Enhanced 911 capability 100 100
State has a uniform system for providing pre-arrival instructions YES YES
State uses CDC guidelines for state field triage protocols NO
State has or is working on a stroke system of care YES YES
State has triage and destination policy in place for stroke patients YES
State has or is working on a PCI network or a STEMI system of care YES YES
State has triage and destination policy in place for STEMI patients YES
State maintains statewide trauma registry YES NO
State has triage and destination policy in place for trauma patients YES
Prescription drug monitoring program score (range 0-4) 1
% of hospitals with computerized practitioner order entry 15.4 74.1
% of hospitals with electronic medical records 46.2 96.3
% of patients with AMI given PCI within 90 minutes of arrival 63 93
Median time to transfer to another facility for acute coronary intervention 50
% of patients with AMI who received aspirin within 24 hours 100
% of hospitals collecting data on race/ethnicity and primary language 78.1
% of hospitals with or planning to develop a diversity strategy or plan 62.5

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