New Hampshire earns an A, ranking 8th of 51 states on overall health. For a state of just 1.4 million people, smaller than most American metros, that's a genuine achievement. The death rate sits at 7,405 per 100,000 against a national average of 10,368. Child poverty ranks best in the country. Food insecurity ranks best in the country. Residents smoke less, move more, and earn about $20,000 more than the national median. The scorecard reads like a success story.
But one number doesn't fit. New Hampshire ranks worse than 42 other states on Medicare opt-outs. At 12.1 opt-outs per 1,000 CMS-enrolled providers, the state posts a rate nearly five times that of Kentucky, which sits at 2.7 despite ranking 44th overall. A state with significantly worse health outcomes keeps its doctors inside Medicare at a rate more than four times better. That's not a statistical quirk. It's a market signal about who New Hampshire's health system is actually built to serve.
The strengths are real. High incomes, low poverty, active residents, and strong insurance coverage compound into genuinely better health. But the same demographic advantages that drive those numbers also fuel a private-pay culture among physicians that could quietly hollow out access for the aging and the less affluent. New Hampshire is healthy today. Whether it's building a system that stays healthy is a different question.
The gap between New Hampshire and the national average isn't concentrated in one area. It runs across nearly every indicator the data can reach.
Start with the headline: a death rate of 7,405 per 100,000 against a national figure of 10,368. That roughly 3,000-life gap doesn't come from a single policy or program. It comes from years of compounding advantages in the indicators that actually predict mortality.
Obesity affects 31.7% of adults here versus 37.5% nationally. Nearly one in three residents is still obese, and that still drives cardiovascular disease, Type 2 diabetes, and joint deterioration. But the six-point gap matters: fewer hospitalizations, fewer surgical interventions, longer functional lives. That figure compounds with physical inactivity at 20.7%, ranking 6th best nationally. New Hampshire adults are genuinely moving more than their peers.
Smoking sits at 11.7%, also 6th best nationally, nearly five points below the national rate of 16.1%. Fewer smokers means less COPD, fewer lung cancer diagnoses, and lower vascular risk across the population. The uninsured rate of 7.2% runs below the national 11.4%. That's roughly one in fourteen adults without coverage. In a high-cost New England market, being uninsured isn't a minor inconvenience.
A median household income of $85,746 runs about $20,000 above the national median of $65,754. That advantage touches almost everything downstream: diet quality, housing stability, the ability to pay for care out-of-pocket. It also shapes child poverty, ranked best in the country at roughly 11%. Mississippi, ranked last overall, sits near 29.9%. The effects of childhood poverty compound into adult health deficits that take decades to manifest. New Hampshire's low child poverty rate is, in a real sense, an investment in people who aren't sick yet.
The CDC's state-level measurements don't just show New Hampshire beating the national average. They show it beating the average consistently, broadly, and by meaningful margins across almost every category measured.
Dental visits lead the list: 66.4% of adults visited a dentist or dental clinic in the past year, against a national average of 57.8%. That 8.6-point gap is the largest deviation in the state's CDC profile. Oral health functions as a proxy for general engagement with healthcare. People who see dentists tend to have primary care relationships, catch problems early, and manage chronic conditions more actively. The confirmation appears in senior tooth loss: just 9.7% of adults 65 and older have lost all their teeth, compared to 16% nationally.
Disability rates show the next biggest deviation. Only 26.4% of New Hampshire adults report any disability, against 33.5% nationally, a gap of more than 7 points. Mobility disability affects 11% here versus 15.1% nationally. These reflect years of lower obesity, more physical activity, and better preventive care compounding into less functional decline over time.
Self-rated poor health sits at 14.8% against 21.3% nationally. Residents don't just measure better on clinical markers. They feel better. High blood pressure affects 31% here versus 36.1% nationally. Diagnosed diabetes sits at 8.9% against 12.4% nationally.
The pattern is coherent: economic stability, low food insecurity, physical activity, and decent insurance coverage produce better outcomes across nearly every measurable dimension. The risk of that pattern is complacency. States that build health on demographics rather than systems can look excellent right up until the demographics shift.
Before a patient ever walks into a clinic, the conditions of their daily life have already shaped their health trajectory. New Hampshire's social environment is, by the numbers, among the least corrosive in the country.
Food insecurity affects just 10.3% of adults, ranked best nationally and 6.5 points below the national 16.8%. Only 7.4% received food stamps in the past year against 13.6% nationally. Food insecurity isn't merely a welfare statistic. It drives chronic stress responses, impairs sleep and cognitive function, and forces the trade-offs between rent and nutrition that degrade health over years of compounding deprivation.
The social radar shows a state outperforming national benchmarks on every dimension it tracks. Housing insecurity touches 8.8% of residents compared to 13.2% nationally. Utility shutoff threats affected just 5.9% of adults versus 9.2% nationally. Lack of reliable transportation, which in a rural New England state can mean effectively no access to care, affects 6.1% here against 9.1% nationally. These numbers represent the scaffolding of daily stability that lets people actually engage with their health rather than survive around it.
The picture isn't uniformly clean. Housing costs in New Hampshire are genuinely high, and the state's prosperity attracts demand that prices out lower-wage workers and younger families. Severe housing cost burden still affects roughly one in eleven residents. The rural north, particularly Coos County, faces transportation and isolation challenges that statewide averages obscure. A state average of 6.1% lacking transportation means some corners of the state are doing considerably worse than that figure suggests.
New Hampshire has 28,320 total healthcare providers, with 10,321 enrolled in Medicare. The top specialties tell their own story: Nurse Practitioners lead at 2,863, followed by Mental Health Counselors at 2,698 and Clinical Social Workers at 2,006. More mental health providers than family practice physicians in the state's top specialty rankings. That's a system responding to visible pressure, not building capacity ahead of it.
The provider total looks substantial in aggregate. Shortage designations tell a different story. There are 65 primary care shortage areas affecting 1.54 million designated-population residents. 58 mental health shortage areas are designated, and 35 dental shortage areas cover 428,000 people. The scale of those designations signals genuine gaps in coverage.
The state's 28 hospitals serve a dispersed population. Dartmouth Health, anchored in Lebanon, functions as the dominant academic system. Concord Hospital and Catholic Medical Center in Manchester serve the southern tier. The North Country, running through Coos and northern Grafton counties, depends on critical access facilities with limited specialty capability. Patients needing complex cardiac care, neurosurgery, or oncology routinely travel to Dartmouth or Boston. That's manageable from Nashua. It's genuinely difficult from Berlin.
Telehealth is a relative bright spot. 21.9% of CMS-enrolled providers offer telehealth services, ranking 4th best nationally. Mississippi, at the bottom of national health rankings, has a telehealth adoption rate of just 6.9%. In a small, mostly rural state with hard winters, that adoption rate isn't incidental. It's load-bearing infrastructure for the shortage areas that can't otherwise reach specialists.
New Hampshire records 623.8 emergency room visits per 1,000 Medicare beneficiaries. For a top-ten state, that number deserves a closer look.
High ER utilization in an otherwise healthy state often signals something specific: gaps in primary care access that push patients toward emergency departments for conditions that could have been managed outpatient, with earlier intervention, at lower cost. The 65 primary care shortage areas affecting 1.54 million designated residents connect directly to this figure. People in underserved areas don't simply forgo care. They defer it until the situation becomes acute, then arrive at an emergency department with a condition that has been deteriorating for weeks or months. That path is more expensive, less effective for managing chronic disease, and harder on the patient.
Hospital readmission data shows a figure of roughly 20%, though this is rounded data and should be read as a general indicator rather than a precise measurement. The more telling story is in the ER volume itself, and what it implies about whether patients in shortage areas are actually getting the primary care they need before a crisis forces their hand.
The financial architecture of New Hampshire's health system begins with a structural advantage. Median household income of $85,746 runs about $20,000 above the national median. An uninsured rate of 7.2%, nearly four points below the national 11.4%, means most residents have coverage when they need it. Together, those two facts cushion the financial exposure of illness in ways that lower-income, higher-uninsured states can't replicate.
Medicare drug spending reached $1.52 billion in total claims, covering 9.36 million prescriptions from 6,262 prescribers across 972 unique drugs. Atorvastatin Calcium leads in volume at 510,723 claims and a manageable $7.9 million in cost, reflecting widespread generic cholesterol management. Levothyroxine Sodium at 329,627 claims reflects thyroid disease prevalence. Lisinopril and Amlodipine Besylate together account for over 618,000 claims for blood pressure management, tracking the cardiovascular risk that persists even in a relatively healthy state.
The most striking cost is Apixaban, a branded blood thinner: 173,865 claims at $155.25 million in total cost. That's roughly twenty times the cost-per-claim of atorvastatin. Brand-name anticoagulants remain among the most expensive drug categories in American medicine, and their prevalence in an aging New England population tracks with atrial fibrillation and stroke prevention in an older demographic. Gabapentin appears at 241,976 claims, prescribed for nerve pain and seizures but also rising as an opioid substitute. The Northeast's ongoing substance use struggles make its volume worth watching over time.
Insurance networks are led by Aetna with 12,179 participating providers, Cigna with 11,443, and UnitedHealthcare with 10,851. Medicare covers 10,321. The presence of two BCBS Massachusetts plans, covering 2,022 and 1,716 providers, reflects a geographic reality: southern New Hampshire's economy is deeply integrated with Massachusetts, and many residents work across the border or seek specialty care in Boston.
The pharmaceutical industry paid 3,757 New Hampshire providers a combined $7.18 million across 31,897 transactions from 447 companies. At an average payment of $225, the number sounds routine. The distribution is more revealing.
Speaking and faculty fees totaled $2.59 million across 885 payments. That's the largest single category by dollar value. These aren't the industry's most common engagement vehicle. These are physicians serving as paid spokespersons and educators for pharmaceutical companies, actively promoting products to colleagues and trainees. Consulting fees added another $1.79 million across 584 transactions.
Food and beverage payments generated 27,489 individual transactions totaling $950,156: the working lunches and dinner programs that keep brand names circulating in clinical conversations. Royalty and license payments, small in count at just 23 transactions, generated $755,560, suggesting a handful of providers with substantive intellectual property relationships with industry. Travel and lodging added $723,028 across 2,193 trips, covering conferences, advisory boards, and speaker training events.
Pharmaceutical payments don't automatically indicate compromised prescribing. But in a state where branded therapies like apixaban account for a disproportionate share of drug costs, the concentration of speaking and consulting relationships among a subset of providers deserves attention from patients and payers alike.
The formal exclusion picture is clean. Just 16 providers are currently excluded from Medicare and Medicaid participation, 0.6 per 1,000 CMS-enrolled providers. That's a low figure reflecting a provider population without significant patterns of fraud or abuse flagged by federal oversight agencies.
The Medicare opt-out rate is a different matter entirely. 344 providers have formally opted out of Medicare, 12.1 per 1,000 CMS-enrolled providers, ranking worse than 42 other states. Kentucky, ranked 44th overall on health, has an opt-out rate of just 2.7. A state with significantly worse health outcomes keeps its doctors inside Medicare at a rate more than four times better than New Hampshire. That comparison should give pause.
What does 12.1 opt-outs per 1,000 mean in practice? It means 344 physicians have concluded that Medicare's reimbursement schedule is incompatible with their practice model. In New Hampshire, where incomes are high and patients can often afford to pay out-of-pocket or through premium private insurance, opting out is an economically rational choice for a physician serving an affluent patient base. The result is a provider ecosystem quietly organizing itself into two tiers: those who participate in Medicare, and those who have exited it.
As New Hampshire's population ages, and it will age like all of New England, those 344 opt-out providers represent a gap that will widen. The A grade is earned today, partly by a demographic that can currently pay around the system's weak spots. That capacity won't last indefinitely.
For a top-ten state, New Hampshire's research infrastructure is thin.
3,301 active clinical trials ranks worse than 40 other states. Texas, ranked 36th overall, runs 40,768 trials. New Hampshire's count is roughly 8% of that total from a state ranked 28 spots higher. NIH funding tells the same story: $20.37 million across just 36 grants, ranking worse than 36 other states. For a state that hosts Dartmouth Health and the Geisel School of Medicine, legitimate academic institutions with national reputations, that's underwhelming.
Dartmouth has historically produced influential health policy research, most notably the Atlas work on geographic variation in Medicare spending, which shaped national conversations about healthcare waste. But translational clinical research, the kind that generates NIH grants and enrolls patients in trials for new therapies, hasn't followed.
Why does that matter? A state with serious shortage area gaps and an aging population needs to be generating new evidence, not just consuming it. The gap between what New Hampshire knows about health and what it's contributing to national health research is a missed opportunity at scale.
New Hampshire has just 10 counties. Small canvas. But the distance between its best and worst is a 2.3-to-1 gap in death rates, visible across a state you can drive across in two hours.
Rockingham County anchors the state's health performance. Its death rate of 5,001 per 100,000, supported by Portsmouth, Exeter, and the prosperous communities along the Massachusetts border, reflects median household income of $109,660, the highest in the state. That income produces health outcomes approaching those of the best-performing counties nationally. San Juan County in Washington, the strongest county in the country, records a death rate of 3,315. Rockingham isn't far behind by comparison.
Coos County is the counterpoint. The northernmost county, home to Berlin and the mill towns along the Androscoggin River, records a death rate of 11,270, more than twice Rockingham's rate. Obesity there reaches 40%, against 30% in most other New Hampshire counties. Median income sits at $59,592. Coos has been losing population for decades, its paper industry gone, its young people leaving, its healthcare infrastructure stretched. It looks less like a New Hampshire county and more like a county in a struggling rural state.
Grafton County, home to Dartmouth Health's main campus, records a death rate of 6,278, suggesting that proximity to a major academic medical center offers some protective effect even in a predominantly rural geography. Hillsborough County, anchored by Manchester and Nashua, sits at 6,909 with median income of $103,181. Merrimack County, home to the state capital, sits at 6,692 with income of $91,357.
The pattern is the one you'd predict: counties integrated with the Massachusetts economy, with high incomes and dense provider networks, do well. Counties in the north, economically isolated and geographically remote, don't. It's New England's rural-urban divide made visible in a state small enough to see it clearly on a single map.
New Hampshire's A isn't luck and it isn't spin. The mortality gap, the low poverty, the active population, the high incomes: these are real and they compound into genuinely better health. But a state that earns its grade primarily by deploying demographic advantages, then allows 344 physicians to exit Medicare while its rural north posts death rates double the southern tier, hasn't built a health system. It's inherited a healthy population and called the inheritance a policy success.
The gaps are structural, not incidental. Coos County's 40% obesity rate and $59,592 median income aren't correctable with a wellness program. The primary care shortage covering 1.54 million designated residents isn't fixable by pointing at the overall provider count. The Medicare opt-out rate that ranks worse than 42 states isn't a quirk of local culture; it's a market signal that New Hampshire's physicians have calculated they can do better outside the public insurance system. These are choices, built into how care is organized and compensated.
The real test comes as the population that built New Hampshire's health profile ages into Medicare and begins requiring the kind of sustained, coordinated care that an opt-out, shortage-riddled, research-thin system is poorly equipped to provide. The states that will hold their grades through that transition are the ones building infrastructure now, keeping physicians inside public insurance, and closing the county gap before it widens further. New Hampshire has the wealth to do all of that.
The question is whether that wealth becomes investment, or just stays wealth.