A Disconnect in Delaware’s Healthcare: A Call for Reform
By: Jane Brady, Chair, A Better Delaware
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 senior citizens, who, while suffering declining health and often on fixed incomes or Medicare coverage, have difficulty in navigating and accessing the healthcare they need. Those factors are cost, access to care and quality of care.
In fact, the report ranked Delaware 49th among the states and the District of Columbia. Sadly, the report noted that Delaware was 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 seniors is important.
You might wonder then, why US News and 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 seniors who suffer – we all do. The average wait time in an emergency room is over 3 hours, 6th 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 preventative care were not met. Indeed, the director of health care reform for the Delaware Department of Health and Social Services acknowledged there is a “disconnect” between spending and the quality of health outcomes. So, what can we do?
Sadly, we need to look no farther 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 any entity or company that wants to either establish or expand their facilities, acquire a new 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 they have taken to try to reduce that spending are flawed. Most recently, they 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 – at the same hearing at which the legislators approved the funds for the panel, they voted to expand the services which were covered by the state and eliminate co-pay 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 they have better results for their citizens, Delaware citizens 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 3 hours. But that is down from nearly 6 hours and 2nd 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
Jazette 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 healthcare outcomes of 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.
Jane Brady serves as Chair of A Better Delaware. She previously served as Attorney General of Delaware and as a Judge of the Delaware Superior Court.