Delaware fell four spots in The Commonwealth Fund’s 2018 Scorecard on State Health System Performance, released May 4, ranking in the bottom half of states in a variety of health measures including adults who smoke, annual diabetes treatment testing and adults who are obese.

Delaware ranked 22nd among all the states on the more than 40 measures, which are divided among access to health care, quality of care, efficiency in care delivery, health outcomes and income-based health care disparities. Delaware’s worst trend was in deaths from suicide, alcohol and drug use increasing from 38.2 deaths per 100,000 population in 2013 to 49 deaths per 100,000 in 2016. Delaware ranked 31st in that category among the states.

On the positive side, Delaware ranked in the top five in three categories, including the top ranking for the lowest rate of deaths within 30 days of hospital discharge among Medicare beneficiaries. The state ranked third for the lowest rate of adults with a mental illness reporting an unmet need and fourth for the lowest rate of children ages 19-35 months who did not receive all recommended vaccines.

“This is another national health scorecard that indicates we are not a top state for overall health, despite being one of the top-ranked states in terms of per-capita health care spending,” said Delaware Department of Health and Social Services Secretary Kara Odom Walker. In June 2017, a Centers for Medicare and Medicaid Services analysis found that Delaware ranked third among the states for per-capita health care spending in 2014 at $10,254, or 27 percent above the U.S. average of $8,045. If that rate is maintained, CMS estimated that Delaware’s overall health care spending could double by 2025.

In September 2017, Gov. John Carney signed House Joint Resolution 7 authorizing DHSS to develop a health care spending benchmark to bring transparency to how Delaware’s health care dollars are spent across the system — commercial insurers, Medicare and Medicaid. In February, Carney signed an executive order creating the Health Care Delivery and Cost Advisory Group to advise Walker on the creation of statewide health care spending and quality benchmarks.

Karyl Rattay, director of DHSS’ Division of Public Health, said the rankings show there is more work to do to improve population health across the state. In a note of caution, Rattay said The Commonwealth Fund appeared to report Delaware’s infant mortality rate incorrectly at 9.1 deaths per 1,000 live births in 2015. Rattay said Delaware’s rate peaked at 9.3 deaths per 1,000 live births for the five-year period ending in 2005 and has declined to 7.5 deaths per 1,000 live births for the five-year period ending in 2016.

In another national health scorecard released earlier this year, Delaware ranked 30th in United Health Foundation’s 2017 America’s Health Rankings Annual Report, exceeding the national average in drug deaths per 100,000 population, obesity and physical inactivity rates among adults, cancer deaths per 100,000, diabetes rate among adults and violent crime offenses per 100,000. Delaware’s 2017 ranking improved one spot from 2016.

To read The Commonwealth Fund’s 2018 Scorecard on State Health System Performance, visit bit.ly/2FL0Lps.