Why Delaware's Health Care Regulations Are Hurting Consumers

Access to affordable and high-quality healthcare is one of the top concerns for Delawareans today. But while policymakers focus on improving access, one regulatory program may be doing more harm than good: Delaware's Certificate of Public Review (CPR) program. This program, designed to manage healthcare facilities and services in the state, is failing to deliver on its promises. Instead, it's creating barriers to competition, driving up prices, and limiting the choices available to consumers.

As we look at the effects of this regulation, it’s important to ask: Is the CPR program really protecting Delaware’s healthcare system, or is it just protecting the interests of a few established providers?

What is a Certificate-of-Need (CON) Program?

Delaware’s Certificate of Public Review (CPR) program is one example of a Certificate-of-Need (CON) law. A Certificate-of-Need (CON) program requires healthcare providers to demonstrate that there’s a genuine need for more facilities, equipment, or services before they can expand or build new ones. Originally created with the intent of controlling healthcare costs, the program was grounded in the idea that too much capacity in healthcare would drive up costs. However, according to the U.S. Department of Health and Human Services, U.S. Department of the Treasury, and the U.S. Department of Labor, there is little evidence to suggest that CON programs actually help control costs or improve the quality and access to healthcare. In fact, the federal government eliminated the incentive to create CON laws in 1987.

The core problem with CON regulations, including Delaware’s CPR program, is that they often create a barrier to competition. With fewer competitors in the market, existing healthcare providers can charge higher prices and have less incentive to improve efficiency or quality. For this reason, the Federal Trade Commission and the Anti-Trust Division of the U.S. Department of Justice urge the elimination of state CON programs, citing numerous instances of anti-competitive behavior by suppliers that were facilitated by these regulations.

The Anti-Competitive Effects of Delaware's CPR Program

Delaware’s CPR program restricts new healthcare providers from entering the market under the guise of ensuring there is enough capacity to meet the population's needs. According to a 2021 staff report to the Delaware General Assembly, the CPR program considers factors like the "need of the population," the effect on existing providers, and the impact on cost and quality. While these factors seem reasonable on the surface, the program's actual effect is more about shielding current healthcare providers from competition than improving quality.

Applicants for a CPR must provide extensive data, including demographic information, utilization rates, and financial data, which is made public and could give competitors an advantage. In fact, of the 28 CPR applications from 2014 to 2020, only two were denied—but there's no data on how many potential applicants chose not to apply because of the regulatory obstacles. Even when applications are filed, the process is slow, with many taking months to be approved. For example, of 30 applications, only six were decided within 90 days.

These delays raise costs for potential new entrants and discourage much-needed competition in an already restrictive market.

The Real-World Impact: Fewer Choices and Higher Costs

If CON laws, like Delaware’s CPR program, were effective, they would help reduce costs, promote competition, and improve the quality of care. However, the evidence suggests that the opposite is true. A recent meta-analysis by economist Matthew D. Mitchell foundshows that states with CON laws experience higher healthcare spending, lower quality, and decreased access to care, particularly among underserved populations. Further research by economists Thomas Stratmann, Markus Bjoerkheim, and Christopher Koopman also show that access improves when CON laws are repealed—especially in rural areas that tend to suffer the most from a lack of competition.

For Delaware’s residents, the consequences are clear. Health services are often oversaturated and inefficient, with patients facing long wait times for appointments. Complaints like, “I can’t get an appointment until next month” or “I can’t get a cancer appointment for three months” are not isolated cases but reflect a broader problem across the state. According to a 2025 West Health-Gallup survey, Delaware ranks 46 out of 51 states for overall healthcare experience and 48 out of 51 for cost and access.

This lack of access, combined with high prices, leaves Delawareans with fewer choices and worse health outcomes. Meanwhile, existing healthcare providers remain shielded from competition and have little incentive to reduce costs or improve their services.

Efforts to Reform Delaware’s CPR Program

In March 2021, the Joint Legislative Oversight and Sunset Committee conducted a review of the performance of the Health Resources Board, the regulatory body responsible for reviewing and approving CPR applications. The review revealed several issues, including conflicts of interest among board members, delays in decision-making, and a lack of transparency. The committee recommended reforms such as turning the Health Resources Board into an advisory body, creating a statewide database of healthcare facility utilization, and reducing the board’s membership. However, these recommendations don’t address the main problem: the CPR program continues to serve as a significant anti-competitive barrier.

Why Reform Is Urgently Needed

Delaware’s CPR program, as it currently stands, is not delivering on its promises of improved healthcare quality or reduced costs. Instead, it serves as a barrier to new providers entering the market, contributing to inefficiency and higher costs. The result is longer wait times for appointments, fewer healthcare options, and reduced access to critical services—especially in underserved areas.

The real impact of this regulatory framework is evident in the frustration expressed by both residents and potential healthcare providers.

As one provider noted, “We don’t want to come to Delaware because of the CON law. It isn’t worth the investment to risk approval.”

The existence of the CPR program itself creates a chilling effect on new investments, further limiting access to care.

What’s more, there is little public support for maintaining the CPR program. The support that does exist appears to come from private lobbying, not the needs or interests of Delaware’s citizens. This points to a regulatory system where industry insiders have more influence than public demand, leaving consumers without a voice in the decision-making process.

Conclusion: Time for Change

Delaware’s citizens are paying the price for a regulatory program that restricts competition and hinders access to affordable healthcare. The evidence is clear: Certificate-of-Need laws, including Delaware’s CPR program, do not improve cost, quality, or access to healthcare. Instead, they protect established providers at the expense of consumers.

It’s time for Delaware to act. By repealing the CPR law and adopting policies that encourage competition, the state can ensure that all Delawareans have access to affordable, high-quality healthcare.

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