Fixing Delaware’s Healthcare: Why Free-Market Solutions Matter
By: Jane Brady, Chair, A Better Delaware
Delaware has long struggled with providing easy access to superior health care at a reasonable cost. A number of factors have affected the failure to meet those goals, but public policy is a significant part of the picture.
Delaware spends more than$12,000 annually per person in the state, at the top (fourth highest) of spending among all the states. Yet the outcomes are bottom rate – we have the highest per capita overdose death in the country, we have the worst shortage of primary care physicians – meeting only 16% of our need, and Delaware hospitals have the second worst (longest) wait times in the emergency rooms in the country.
Why? We have a heavy-handed bureaucracy and policy mandates that makes care more costly, reduces incentives to innovate and discourages competition.
We at A Better Delaware have long encouraged lawmakers to get rid of the Certificate of Need, now called the Certificate of Public Review, which puts a group of individuals, some associated with providers already operating in the State, in charge of deciding if a new provider can enter the market, or any provider can offer new technology, additional bed space or expand services. This requires providers to grant others permission to compete with them. What could go wrong? Nearly every state that ever had a certificate of need requirement has revoked them, and Delaware should too. Studies consistently find the certificate of need decreases access, increases costs and negatively affects quality of care.
Recent legislation has only tightened the strain bureaucracy puts on health care providers. In the name of containing costs, the legislature has placed a politically appointed panel in charge of reviewing hospital budgets to oversee how much and for what health care providers are proposing to spend. Again, what could go wrong? We are only the second state to enact such a bill, and the first found it to be a failure by most accounts.
Reimbursement rates for primary care physicians is lower than for most other categories of providers, yet, because they know their patients, they can provide better diagnoses and assessments, make a better determination of what additional care is needed, and save the high cost of a visit to the hospital for patient and insurer. They need fair reimbursement rates, but recent legislation would again impose mandates on insurers and providers that is driven solely by cost and not focused on the objectives of improved access and quality care.
And, we have to question how well informed any decision about the cost of health care can be under the current practices and the consistent failure of providers to comply with price transparency laws. Delaware has laws that require providers to make costs clear to patients, for example, the cost of a CT scan, knee replacement or the birth of a child. Knowing that information would allow patients to choose where to undergo testing or procedures. There is little to no compliance with those laws, and so, whether patient or legislator, it is hard to know how one can competently identify any problems, let alone solve them.
Delaware’s policies that put politicians in charge of health care expansion or operation, restrict competition and hinder excellence and competition are a large part of the problem with providing quality and accessible care in our state. Enforce the laws requiring transparency and create more competition which will encourage more providers to locate here. Let’s create a health care community in which providers can give their patients the care they know our community deserves.
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.