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.
“We must reform certificate of need to increase both access to and competition.” So said Gov. Matt Meyer, in his State of the State on Jan. 22, as he spoke about health care in Delaware.
What a relief to hear those words. We at A Better Delaware have advocated for reform of the certificate of need law — or certificate of public review, as it is now called in Delaware — for a number of years. We have cited repeated studies that show that removing the certificate of need requirements will increase access to, the cost of and the quality of health care in Delaware.
A certificate of need is, essentially, permission — required to be approved by a committee appointed by the political process — to open a facility or expand health care services, even to add imaging technology or more bedspace to an existing facility. Those who serve on that committee often operate competing facilities. That process has been shown to keep new competition from entering the market, leaving fewer health care choices for patients.
While the federal government first thought certificate of need laws would improve prices and service, in the mid-1980s, Congress repealed the law requiring such programs, acknowledging that the law had failed to meet the goal of controlling health care costs.
Since then, most states have repealed their certificate of need laws. They have concluded, reasonably, that they do not help the citizens of their states receive quality health care at reasonable costs in reasonable periods of time.
As with many issues, the cost of certificate of need laws was made more clear during the pandemic. One study, published in the Journal of Risk and Financial Management, found that hospitals in states with certificate of need laws are 27% more likely to run out of beds. The capacity was not there because those laws restricted expanded access to care.
The impact also extends to cost. In a cost-of-care survey, conducted by CareScout and Genworth, Delaware was found to be in the top 10 most expensive states for the cost of assisted living and semi- and private care facilities.
Delaware also has the third longest wait for emergency room care in the country — over 214 minutes. When you consider that many hospitals have opened smaller, emergency care facilities throughout the state, some of which see a patient before they are fully checked in, the actual time in the emergency rooms can be much longer. Indeed, before Delaware hospitals opened those smaller facilities, the average wait time in Delaware emergency rooms was over five hours.
In addition to the high cost of, and restricted access to, health care, Delaware suffers a severe shortage of doctors. According to the Health Resources & Services Administration, as cited in Becker’s Hospital Review, Delaware stands last among states for access to primary care physicians.
Recently, the federal government has made it even clearer that these laws are not effective and should be repealed. Federal assistance to states for rural health care and hospital programs has, in some instances, been conditioned on the repeal of certificate of need laws. Other states have simply taken the initiative to repeal or reform them. Delaware would be well served to follow their paths.
We are pleased to hear the governor’s words and hope that he will take charge and lead an effort to encourage more access, lower costs and better health care for Delaware patients.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
