Jane Brady is the chair of A Better Delaware. She previously served as state attorney general and as a judge of the Delaware Superior Court.
If you open up the 2024 Senior Healthcare State Report Card on the SeniorLiving.org website, the first key finding shows that Delaware gets an F grade. The report looks at three key factors affecting older adults, who, while suffering declining health and often on fixed incomes or Medicare coverage, have difficulty navigating and accessing the health care they need. Those factors are cost, access to care and quality of care.
In fact, the report ranks Delaware 49th among the states and the District of Columbia. Sadly, the report notes that Delaware is the only state to rank 40th or worse in all three categories. Drug costs are notably high — in fact, 39% higher than the national average. And the report found that we have the worst stroke death rate in the nation.
Why is this important in the big picture in Delaware? Because we have a rapidly aging population, growing at a rate faster than the rest of the nation, and are the fifth “oldest” state in the nation. How we deliver, and how well we deliver, health care to older residents is important.
You might wonder then why U.S. News & World Report just ranked Delaware second in the nation for hospital quality. It is in the delivery of care. The inefficient use of our resources has resulted in poor health outcomes for Delawareans.
And it is not just older adults who suffer — we all do. The average wait time in an emergency room is over three hours, sixth worst in the nation. And a recent report by the Delaware Department of Health and Social Services made clear that benchmarks related to cancer screening, opioid deaths, the use of statins for heart health and other preventive care were not met. Indeed, the director of health care reform for DHSS acknowledged that there is a “disconnect” between spending and the quality of health outcomes. So, what can we do?
Sadly, we need to look no further than our own public policies to see how to improve cost, access and quality. Delaware is one of a shrinking number of states that still retains an archaic law requiring a “certificate of need.” That law requires that any entity or company that wants to either establish or expand their facilities, acquire technology or offer new services to get permission from a government panel, on which other health care providers serve. As one person put it, imagine Burger King having to ask permission to build a restaurant and McDonald’s sitting on the committee that will decide. That is precisely what the certificate-of-need law does. It allows current providers to decide how much competition they will have. Studies, including those done by the Institute for Justice, consistently show that states with certificate-of-need laws have higher costs and inferior access to care and health outcomes.
Delaware’s legislature has recognized we are spending more, but the steps it has taken to try to reduce that spending are flawed. Most recently, it established a government-appointed panel to review hospitals’ budgets and gave the panel the authority to override spending decisions by the hospital. We have written before about how ill-advised this law is — it will discourage new providers and companies from coming to Delaware, and the only model for the idea is floundering and likely near failure in Vermont.
But talk about disconnect: During the same hearing at which legislators approved the funds for the panel, they voted to expand the services that are covered by the state and eliminate copay fees for those services. We need to be smarter about how we spend our money, and that doesn’t include installing a government supervisory committee over hospital budgets. Competition will bring down prices. New York and California, which have no certificate-of-need laws and more open competition, have multiple hospital providers, and have better results for their citizens. Delaware residents would be better served if we adopted policies that allow the ingenuity, creativity, experience and expertise of those who provide medical care the opportunity to fully offer those services, without impediment or government interference.
Finally, more transparency in the pricing of health care services would help patients make better and more appropriate decisions about where to get care. We do have laws that require information to be made available, but they are not uniformly followed, and there is no enforcement.
There is some good news. To give credit, the walk-in centers, now associated with our hospital systems, have made a big difference in the overuse and drain on emergency room staff. As reported, we have emergency room wait times of over three hours. But that is down from nearly six hours and second worst in the nation a few years ago.
And, we have information. The benchmark report on the quality of health care and health outcomes is an open book that lets us know what our objectives are, and where we are getting better, or not, in meeting those objectives. And we have an honest broker in Josette Manning, secretary of the Department of Health and Social Services. In discussing the benchmark report, she acknowledged that there is still significant work to be done to improve health care outcomes for Delawareans.
Every state agency leader should establish and publish goals for their agency, and regularly report on their progress or lack thereof, whatever the facts reflect. With specific goals, focused effort and public scrutiny, our government will work better for us — the citizens who fund it and who it is to serve.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org .
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