Delaware’s Healthcare Metrics: A Triple Medical Miss
By: C.D. Casscells, MD, Guest Contributor
Delaware is going broke over healthcare costs. About 1$ of every 4$ of the State budget is for healthcare. (Normal is 1/6). There is huge fraud in the State Medicaid system and the State Auditor was denied access to audit Health and Social Services which begs the question, “What are they hiding?” Delaware’s hospital costs are higher than the norm, and its quality outcomes are below average. Based on the higher hospital costs, health insurance costs more than in neighboring states. Many companies in Delaware self-insure to better manage their costs but are still subject to the high cost of hospitals in the state.
On the good side, Delaware does not have a shortage of Primary Care providers. There is generally pretty good access tchild birthing care statewide. Delaware specialty care is also good in Delaware. Malpractice insurance rates are high but not unreasonable like Pa., where rural hospitals are closing in droves. After all, Delaware doesn’t have any rural hospitals. Basically, Delaware has only one hospital system in each county. And Delaware has only one health insurer, Highmark BCBSDe. There is no choice.
Also, the two largest employers purchasing insurance and healthcare in the state are the State itself and Christiana Care Health Systems. Delaware has very few skilled nursing facilities, the 3rd fewest in the nation, to serve our rapidly aging population. To exacerbate this, our best SNF’s have very few if any Medicaid beds, so the Medicaid and Obamacare patients are particularly underserved with very limited access to covered beds.
So, by the three classic metrics of Healthcare Policy, Cost, Quality, and Access, we aren’t doing so well. Why does this matter? Because employers do not want to move here if there is a lousy healthcare environment, any more than they want a lousy school system, which we also have. We used to attract business with our business law and Chancery Court System, but that is no longer as attractive and other states are becoming more appealing. So, if we don’t make cars here anymore, where are the jobs? Well, they are here taking care of retirees from other states like NY, PA, NJ, and MD. where taxes are too high. But will they still want to retire here if healthcare isn’t that good? Our in-migration of retirees with out-of- state pensions and health insurance may be at risk. There goes a cash cow.
What to do? Well, we would all like lower health insurance cost. So, we need more choices to compete. But Health insurers won’t come to Delaware because hospital costs are too high and there is no choice or competition. So, a health insurer cannot make money in this high hospital cost market. Quite obviously the state needs more choices…. providers like hospitals, doctors, outpatient diagnostic and treatment facilities, and nursing homes. More choices mean competition for quality and price, as well as access. Both the private employers and the State need more choices for health insurance and healthcare delivery.
These undeniable economics cannot be fixed by top-down mandate or legislation, rather by removing barriers to entry into the state by the antiquated Certificate of Public Review or a failed office of Insurance Commissioner, or for that matter a newly formed hospital budget review committee. Price-fixing and mandating economics ALWAYS result in untoward unintended consequences. Remove the barriers to competition. Let the supply and demand mechanics do their magic and, by the way, please audit the corrupt and wasteful Medicaid system which is on track to bust Delaware’s budget.
Dr. Casscells is the Director of the Center for Health Policy at the Caesar Rodney Institute.