The Center has done work looking at statewide health care financing in New Hampshire, culminating in the development of a health care dashboard which showed that New Hampshire is a high quality, but high cost health care system. But what about within the state?
A recent article by Atul Gawande describing significant variation in health care costs has made its way to the top of the list for health policy makers around the country. In that article (can be found here) Mr. Gawande describes how McAllen, Texas is one of the most expensive health care systems in the country. Only a few miles away, in El Paso, costs are much lower. Differences in the quality of the care do not explain these differences. Reading this article made us wonder: Is there similar sub-state variation in costs and quality in New Hampshire?
The answer is yes. In a recent analysis of New Hampshire hospital payment levels, the New Hampshire Department of Insurance showed that Exeter Hospital received payments that were almost twice as high as those received by Speare Memorial Hospital in Plymouth for the same set of services. Was the quality of care significantly greater in Exeter? Based on the Centers for Medicare and Medicaid services hospital compare data the answer is no. Of the 26 quality indicators for which the two hospitals had valid data, Speare Memorial had higher quality scores in 20.
The two hospitals described here are very different. One is a very small hospital providing a limited set of services in a rural community and the other is a larger hospital in the relatively more populous Southern part of the state. And direct comparisons of the quality of these two hospitals should be taken with a grain of salt. Nonetheless, that the data here in New Hampshire suggest that there is a twofold variation in payment levels with only small differences in quality measures should give policy makers pause: Is there an opportunity to think about how to improve the value proposition of health care here in New Hampshire?