Project on Health Care Finance:
Covering the Uninsured in New Hampshire & Keeping Health Care Accessible

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.

How are Other States Providing Healthcare Information to Policymakers, Patients, and the Public - April 2006

This report focuses on information on health prices, costs, and quality. The paper’s primary objective is to provide information on other states’ efforts that New Hampshire could adopt in order to expand the amount of useful healthcare information available to the New Hampshire’s policymakers, patients and the public. In addition to New Hampshire, the states that are explored are California, Maine, Massachusetts, Minnesota, New York, Utah and Vermont. The report includes a list of websites for each of the selected states.

Cost-Shifting in New Hampshire Hospitals, 2004 - February 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.

Selected State and National Websites with Information on Quality of Care and/or Health Care Prices - February 2006

This page contains links to websites that are discussed in an upcoming report, "How Are Other States Providing Health Care Information to Policymakers, Patients, and the Public?" We expect to release the report by the end of March, but have posted these links now so that interested participants in the Citizens' Health Initiative can easily peruse these sites themselves. The states are California, Maine, Massachusetts, Minnesota, New York, Utah, Vermont, and New Hampshire.

An Overview of Healthcare Costs, Hospital Finances, and Cost Shifting - February 2006

This PowerPoint presentation was presented by Steve Norton to a committee of the Business and Industry Association on February 20, 2006. 

Peeling the Onion: Inpatient Hospital Care in New Hampshire - February 2006

This report identifies the primary trends within the hospital inpatient market for 2001-2003. The primary finding is that cost-containment strategies focusing on the elderly and the Medicare enrolled population, those accounting for the lion’s share of inpatient utilization, are most likely to be effective at controlling growth in this sector of the health care market.  

Searching for Useful Health Care Prices - January 2006

This report anticipates changes that will occur if responsibility for paying for health care is further shifted onto individuals in the future. It identifies the kind of information consumers will need to make personal health care purchasing decisions. It presents the necessity of having actual prices (not just charges) available so consumers can make intelligent choicest. It presents sources of price and quality information that are currently being designed and built for future use in the New Hampshire health care marketplace, including the following websites:

NHQualityCare quality measures comparing NH hospitals prepared by the Foundation for Healthy Communities and Northeast Health Care Quality Foundation
New Hampshire's Medicine Cabinet price of prescription drugs at various pharmacies in New Hampshire
Dartmouth-Hitchcock Medical Center reports on quality of care
Dartmouth-Hitchcock Medical Center what they charge for certain health care services
New Hampshire HealthCost NH Insurance Department lists typical prices and price ranges for some procedures and services

An Overview of Health Care Costs and What Are YOU Going to Do about Them? - November 2005

This is a revised version of the PowerPoint presentation that was made by Doug Hall at the November 9 "NH Health Care Summit 2005" hosted by BusinessNH Magazine in Manchester.

Basic Facts on Health Insurers in NH, 2001-2004 - October 2005

This report is an update to "Commercial Health Insurers: Intermediaries in Health Care Finance," issued by the Center in October 2004. It presents basic data on the largest companies selling health insurance in the state in 2004 as submitted to the NH Insurance Department. The insurance covered 372,390 lives and the companies were paid over $1.2 billion for this coverage.

State Level Options for Reducing Private Sector Health Care Costs - October 2005

This paper lists eleven ideas for ways to reduce health care costs without simply shifting the cost onto others or reducing access to care or quality of care. Some of the ideas have been debated with regularity, others are offered for a first discussion in the state. 

Health Care Dollars and Health Insurance in New Hampshire, 2004 - September 2005

This report presents basic data about the total costs of the health care system in New Hampshire in 2004. We estimate that the cost of personal health care spending in 2005 will amount to $7.5 billion. The report also presents data on the cost of health insurance and its availability to employees. 69% of full time workers in New Hampshire are enrolled in a health insurance plan while only 10% of part time employees are so enrolled. Other details are presented in the report.

The Third Safety Net - August 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.

Index of Population Lacking Health Insurance, 1st Quarter 2006 - July 2006

Index of Population Lacking Health Insurance, 4th Quarter 2005 - April 2006

Index of Population Lacking Health Insurance, 3rd Quarter 2005 - January 2006

Index of Population Lacking Health Insurance, 2nd Quarter 2005 - October 2005

Index of Population Lacking Health Insurance, 1st Quarter 2005 - June 2005

Monitoring Changes in Health Insurance Coverage - June 2005

This paper, the first in our series, Health Finance Indicators, proposes an Index of of Population Lacking Health Insurance, a method for tracking whether the  population in New Hampshire that lacks health insurance is changing. Data for the years 1999-2004 are presented, showing very little change over this five year period. The Center will make public announcements of the Index each quarter in the future.  

A Framework for Thinking About Cost-Shifting in Health Care - November 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 - November 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? - November 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 - November 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.

Goals or Principles of Health Care Reform - November 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 and Market Competition - November 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 "Cost-Drivers" Please Stand Up? The Problem of Identification - November 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 - November 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 - November 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.

Health Care Access, Cost, and Quality (What We Don't Know Can Hurt Us)  - October 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 - October 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 - October 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 - October 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.

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Part of our research involves collecting and reviewing work being done in other states and at the national level. While we are conducting our research, we will post links to other sites that have reports on health care costs and policy options. We hope that readers will find these helpful.

1. Survey data that include information about access to health insurance and the uninsured 
Current Population Survey (CPS)
National Health Interview Survey (NHIS)
National Survey of American Families (NSAF)
Behavioral Risk Factor Surveillance System (BRFSS)
Community Tracking Study (CTS)
Medical Expenditure Panel Survey (MEPS)

2. Data sources on health care expenditures
Medicaid: Centers for Medicare and Medicaid Services
National and State Health Accounts: Centers for Medicare and Medicaid Services
National Center for Health Statistics
National Economic Census: US Census Bureau

3. Health expenditure data and policy options being pursued in other states.
Delaware: Health Care Commission
Florida: HealthStat
Maryland: Health Commission
Vermont: Division of Health Care Administration
Vermont: Commission on Health Care Availability and Affordability

4. National organizations
Employee Benefits Research Institute
Kaiser Family Foundation
Urban Institute
Robert Wood Johnson Foundation
Center for Studying Health Systems Change

Date last modified: June 13, 2006