Reforming Delaware’s Health Care: Costs, Competition, and Common-Sense Solutions

 By: Jane Brady, Chair, A Better Delaware

Everyone is concerned about the cost of health care in Delaware. The patients and their families who owe medical debt, the legislators in the General Assembly, the hospitals that are accruing increasing mountains of unpaid costs for medical services and the Governor.  Numerous efforts have been undertaken to address the issue, and in truth, most of them are misguided and are likely to be ineffective and unsustainable.

The General Assembly passed the Diamond State Hospital Cost Review Board (HB 350), which establishes a government board to review hospital spending and budgets to determine if they think the hospital could or should align the facility’s priorities differently to cut costs.  Christiana Care has sued to prevent the bill from taking effect, and although members of the panel have been appointed, implementation is already in turmoil.

Recently the Chair of the Board resigned, expressing that he felt the Governor exerted inappropriate influence over the Board’s actions.  The Governor has expressed that he is skeptical that the Board will be effective in cutting hospital costs (a position that we at A Better Delaware share and advocated for prior to the bill being passed). At the very same meeting of the Appropriations Committee that the Board appropriated $700,00.00 to get under way, the same Committee voted to expand the procedures for which the State would pay for their insured to receive, and to eliminate the co-pays for those services by those patients.  The contradiction seemed lost on the members of the Committee who voted to support both provisions.

The Governor partnered with a non-profit, Undue Medical Debt, and provided an initial sum of $500,000.00 to that organization to pay off what even the organization describes as debt that would likely go uncollected, according to CEO Allison Sesso.  Governor Meyer claims it will eliminate $50 million of medical debt for 17,000 Delaware families. If this debt is likely uncollectable, we are essentially using taxpayer dollars to subsidize (further) the hospitals in Delaware.

Behind all these efforts are real people who are not getting the best quality and more effective health care delivery available.  The most significant indicator of that is the time patients wait in the emergency room. Delaware has horrible wait times in the ER, as anyone who has had to visit one knows.  In fact, we are among the worst in the nation, with an average of 3 hours and 31 minutes wait.  It used to be worse, but hospitals have expanded emergency care beyond their four corners and opened remote emergency services at walk in care facilities.  Recently, a trip of an acquaintance to one of these remote ERs resulted in them being called back before their check-in was completed. There was only one other person in the waiting room. So, take her 5 minutes, say, and average it to get 3 hours and 31 minutes and you get an idea of how long your wait in Delaware can be.

And, how long you wait in an emergency room matters. A study by the Office of National Statistics in England found that if you wait 3 hours in an ER, you have a 10% greater chance of dying in the next 30 days than if you only waited 2 hours. And, if you wait 6 hours, which occurs, regrettably, on a regular basis across our state and the country, you have a 60% greater chance of dying in the next 30 days than if you waited only 2 hours.

There are better ways to address both access to care and quality of care. We have said it many times – more competition.  Eliminate the certificate of need as most states have now done. That law puts representatives of facilities already in business providing health care in Delaware in charge of decisions whether other facilities can enter the state to do business or whether new services, equipment or facilities can be offered by others already doing business in the state.  Study after study, since the early 90s support that the quality of care and the access to care improve when the number of services offered and the number of facilities offering those services are increased.

Let’s bring common sense back to the analysis of this, and other, issues. Let’s learn from the experience of other hospitals and health care systems. And let’s look at the long term, sustainable solutions that will give all of us better access to quality health care.

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.