Delaware earns a B, landing at 25th of 51 states with just over 1 million residents packed into the second-smallest state in the country. The grade is earned, not given. And the tension embedded in it matters.
Four in five Delawareans saw a doctor for a routine checkup last year. That's 4th in the nation, ahead of states with larger budgets and shinier overall rankings. Medicare doctors accept patients at a rate of 95.2%, better than 46 states, and actually higher than Rhode Island, which ranks 1st overall in health. Telehealth reaches more than one in five CMS-enrolled providers, 6th in the nation. Only 8 providers are currently excluded from federal programs, one of the lowest figures anywhere. These aren't marginal wins. They represent a healthcare culture that actually functions.
And yet roughly one in five Delaware children grows up in poverty. High cholesterol haunts a population that smokes less and moves at near-average rates. The research infrastructure ranks worse than 44 states on clinical trials. Delaware has built an impressive front door to the healthcare system. Who walks through it, and what changes for them, is the harder question this report tries to answer.
The number that stands out most in Delaware's health profile isn't the obesity rate. It's the cholesterol rate. 38.7% of Delaware adults who've been screened show high cholesterol, against a national 35.1%. That 3.6-point gap doesn't trace back to obesity or smoking, both of which Delaware handles at or below average. It's a genuine outlier in a population that's otherwise doing many things right, and it points toward a cardiovascular burden that the healthcare system is managing but not reducing.
Obesity sits at 37.0%, fractionally below the national 37.5%. Physical inactivity runs at 27.6%, worse than about 35 states. The two conditions feed each other, and together they feed cardiovascular disease, the dominant story in Delaware's prescription drug costs. But they don't fully explain the cholesterol numbers. Diet, genetics, and possibly a screening effect, where Delaware's high checkup rates catch cases that go undetected elsewhere, all play a role. Whatever the cause, elevated cholesterol in a population already filling prescriptions for statins and blood pressure medication means the cardiovascular burden isn't under control. It's being treated.
Smoking is a genuine bright spot. At 13.3% versus the national 16.1%, fewer Delawareans light up than in most of the country. That gap reduces long-term risk of COPD, lung cancer, and heart disease in ways that compound over decades. Delaware doesn't get as much credit for this in its overall ranking as it deserves.
The uninsured rate of 9.5% beats the national 11.4%. Delaware's median household income of $79,129, nearly $14,000 above the national average, gives more families the economic footing to stay covered. But that income average hides something uncomfortable. One in five Delaware children lives in poverty, slightly above the national average of 19.4%, in a state richer than most of the country. The corporate headquarters lining Wilmington's riverfront don't pull up every household in Kent County.
Delaware's divergence from national CDC measures traces a single consistent pattern: this is a state that shows up. Dental visits reached 62.3% of adults against a national 57.8%. Routine checkups hit 80.4% versus 76.3%. Mammography screening among women 50 to 74 came in at 77.5% against 73.7%. Colorectal cancer screening reached 63.6% versus 60.7%. Across every major prevention measure, Delaware outperforms the country. The question isn't whether people are getting screened. The question is what that screening is finding.
The downstream results show up in disability numbers. Overall disability affects 30.6% of Delaware adults against a national 33.5%. Cognitive disability: 13.7% versus 16.1% nationally. Tooth loss among adults 65 and older, a long-term proxy for dental neglect, sits at 13.2% versus 16.0%. Depression affects 21.9% of residents against 23.5% nationally. None of these are dramatic gaps. But they're consistent, and they point toward a population that's been connected to the healthcare system over time.
Then there's the cholesterol finding. Running 3.6 points above the national average, it cuts against every other trend in this chart. Delaware's prevention culture has built the infrastructure to find problems. Screening catches what's there. It doesn't change what's causing it. The harder challenge is getting upstream of the elevated LDL before the statin prescription becomes a lifetime commitment.
Delaware's social determinants look stable by national comparison. Food insecurity affects 14.7% of adults, better than the national 16.8% but still nearly one in seven residents who can't reliably count on the next meal. Severe housing cost burden sits at 12.5% versus 13.2% nationally. Utility shutoff threats hit 8.0% of adults against 9.2% nationally. Across these measures, Delaware runs modestly ahead of the country. The radar chart puts that advantage in visual terms.
What the aggregates don't show is where the stress concentrates. Kent County, centered on Dover and Delaware's agricultural interior, carries a median income of $72,498 against New Castle County's $86,798. The working communities between the coast and the corporate north, the ones that don't draw beach tourism or Fortune 500 tax filings, are where food and housing instability quietly compound into long-term health damage. Delaware is small enough to feel coherent. It isn't so small that poverty distributes evenly.
Lack of social and emotional support affects 22.0% of Delaware adults. That's roughly one in five people managing health challenges without adequate support, slightly better than the national 23.9% but still a substantial number. Social isolation feeds mental health outcomes and medication adherence in ways that don't show up in checkup rates. Delaware has a robust mental health workforce, with 1,222 counselors and 1,205 clinical social workers among its top provider specialties. But 86 designated shortage areas for mental health coverage suggest those providers aren't located where the need is greatest.
Delaware's provider landscape starts with a number that surprises people who haven't seen it. Its Medicare acceptance rate of 95.2% ranks 5th in the nation. Rhode Island ranks 1st overall in health and has a Medicare acceptance rate of 91.8%. Delaware's providers are more accessible to the state's senior population than even the country's healthiest state's doctors are to theirs. In a small state where the major health system, insurers, and regulatory environment operate in close proximity, that coordination shows up in practice patterns.
Telehealth tells the same story. At 21.4% of CMS-enrolled providers offering telehealth, 6th nationally, Delaware has built virtual access into its care model at a rate more than triple Mississippi's 6.9%. For a geographically compact state, that investment signals a care culture oriented toward reach.
The provider workforce leans heavily on advanced practice roles. Nurse practitioners lead all specialties at 1,952, followed by registered nurses at 1,906. Mental health counselors at 1,222 and clinical social workers at 1,205 give Delaware substantial behavioral health capacity for a state this size. Internal medicine physicians reach only 655, well down the list. That reflects a broader national shift toward advanced practice providers, but it also means the physician-to-patient ratio in primary care is thinner than the headline provider count suggests.
Thirteen hospitals serve roughly one per 80,000 residents. The infrastructure exists. So do 86 designated shortage areas each for mental health, primary care, and dental care, with underserved populations in the millions reflecting overlapping catchment zones across Delaware's 3 counties. The problem isn't total supply. It's distribution. Where the providers are, and where the patients are, don't always match.
At 590.5 emergency room visits per 1,000 residents, Delaware's ER utilization tells you something the checkup rate doesn't. More than half the state visits an ER in a given year. In a state with strong Medicare acceptance and above-average insurance coverage, that figure points less toward financial desperation than toward care gaps in specific communities, geographic pockets where the primary care network hasn't followed the population, or where trust in routine care hasn't taken hold.
The shortage designations across all three counties suggest that for many residents, the ER isn't a choice. It's the only available option. There's no open appointment to make instead. Delaware's cardiovascular burden, visible in prescription claims for statins, blood pressure medication, and anticoagulants, also puts a significant share of discharged patients at higher risk of return. Managing those conditions at the population level requires consistent outpatient follow-up, and not every Delaware resident has it.
High ER use can coexist with high checkup rates in a state where one segment of the population has a regular physician and another doesn't. Delaware's access numbers describe the system at its best. The ER numbers describe what happens everywhere else.
Delaware's financial baseline is genuinely favorable. A median household income of $79,129 and an uninsured rate of 9.5% mean more residents can afford coverage and the friction costs, copays, transportation, time off work, that push others toward skipping care. That economic floor is one reason the state's preventive care numbers are as strong as they are.
The prescription drug bill tells the cardiovascular story in dollar terms. Delaware prescribers filed 8.8 million claims totaling $1.75 billion. The most-claimed drug was Atorvastatin Calcium, a cholesterol medication, with 553,207 claims. Amlodipine Besylate for blood pressure ran 347,849. Metoprolol Succinate for heart conditions came in at 304,044. Lisinopril for hypertension added 244,140. The top drugs read like a cardiovascular formulary. The pattern is unmistakable.
Then there's Apixaban. It ranks 8th in claims at 214,925, but it's the single most expensive drug line in the state's entire formulary, at $246.8 million. That's roughly 14% of Delaware's total prescription drug spending, one drug, used to prevent strokes in patients with atrial fibrillation, a common complication of long-term cardiovascular disease. Its dominance here isn't just a cost story. It's a signal about how far the cardiovascular burden has progressed in Delaware's population.
Insurance coverage is competitive. Aetna leads with 8,377 in-network doctors, followed by Highmark BCBS Delaware at 7,192 and Cigna at 7,102. Nearly ten major networks competing for a state of just over a million people creates real coverage choice, at least for residents equipped to navigate that market.
Pharmaceutical companies paid 3,641 Delaware providers a total of $3.18 million through 46,427 separate transactions across 474 companies. The average payment was $68.59. That average tells you what the dominant form of pharmaceutical outreach looks like in this state: food. The Food and Beverage category accounted for 44,178 of those transactions, worth $1.18 million. The working lunch, delivered at office conferences and hospital departments, remains the industry's most reliable and least remarkable access tool.
The larger payments carry more weight. Speaking and faculty compensation reached $703,791 across 311 payments, averaging roughly $2,260 per engagement. Consulting fees totaled $619,171 across 315 payments. These arrangements give companies sustained access to the providers who shape prescribing patterns for hundreds of patients at a time. Travel and lodging added $256,912. Royalties and licenses, a smaller category of just 14 payments, accounted for $158,754.
The spread across 474 companies suggests no single pharmaceutical relationship dominates Delaware's prescribing patterns. The payments are wide, individually modest, and largely unremarkable. What that breadth does mean is that industry contact is nearly universal among active prescribers. It isn't concentrated in a few high-profile relationships. It's woven into clinical practice at low levels, everywhere, continuously.
Just 8 providers are currently excluded from federal healthcare programs in Delaware. That's 3rd in the nation, better than 48 states. California carries 725 active exclusions while ranking 16th overall. Delaware's ratio of 0.4 excluded providers per 1,000 is a genuine positive signal about the integrity of the current provider workforce operating within federal programs.
The historic exclusion count of 223 reflects past enforcement actions over time, not today's exposure. That distinction matters. A low active exclusion count means current risk is minimal, whatever the record shows.
A more consequential number is the opt-out figure. 119 providers have opted out of Medicare entirely, at 6.1 per 1,000 CMS-enrolled providers. For Delaware's roughly 200,000 Medicare beneficiaries, those opt-outs represent physicians they simply can't access through their coverage without paying out of pocket. In a state where Medicare acceptance otherwise reaches 95.2%, the 119 stand in visible contrast. They tend to be concentrated in specialties where private-pay patients are sufficient to sustain a practice independent of government reimbursement rates. For most Medicare patients in Delaware, it won't matter. For the ones who need those specialists, it will.
Delaware's corporate identity and its research identity have almost nothing to do with each other. The state recorded 2,539 active clinical trials, ranking worse than 44 states. California, ranked 16th overall, runs 49,929. NIH funding reached $13.7 million across just 29 grants, against California's $907 million. That gap isn't a rounding error. It's a structural absence.
Here's the irony: Delaware is home to the legal and financial architecture of the pharmaceutical industry. More corporations are incorporated here than anywhere else in the country. The companies that develop the drugs filling Delaware's prescription formulary are technically Delaware entities. The research doesn't happen here.
ChristianaCare, the dominant health system anchored in Wilmington and Newark, has invested in expanding clinical trial participation in recent years, and that effort matters. But at the state level, Delaware's proximity to Penn Medicine, Jefferson Health, the Children's Hospital of Philadelphia, and Johns Hopkins creates a dynamic worth naming: Delaware researchers can collaborate at those institutions, but the grants follow the institutions, and the trials register at the sites conducting them. Delaware has access to nearby research excellence without building its own. For a state this small, that may be a rational choice. What it means for residents is less participation in emerging treatments and less early access to care that trials provide. Someone in a trial in Philadelphia gets next year's standard of care. Someone in Dover gets last year's.
Delaware has three counties. That makes the divide data unusually clean. New Castle County anchors the north with Wilmington, corporate headquarters, and the state's best health outcomes: a death rate of 8,586 per 100,000 and a median income of $86,798. Sussex County in the south draws retirees to its beaches, logging a death rate of 9,330 and income of $78,092. Kent County, the agricultural middle anchored by Dover, has the highest death rate at 10,078 and the lowest income at $72,498.
The gap ratio between best and worst is only 1.2, one of the smaller county divides in the country. But 1,492 additional deaths per 100,000 in Kent than in New Castle is real and preventable. Kent County sits between a state capital and a farming interior, without the specialty resources of ChristianaCare to the north or the retirement economy to the south.
What the dot plot makes plain is what doesn't change across all three counties: a 40% obesity rate, identical regardless of income or outcomes. The behavioral patterns driving chronic disease are evenly distributed even where mortality diverges. That's not primarily an access story. It points to something harder to fix than a shortage designation.
Even Delaware's best county doesn't look exceptional against national peers. New Castle County's death rate of 8,586 is worse than Providence County in Rhode Island at 7,036, Hawaii County in Hawaii at 7,851, and Windham County in Connecticut at 7,901. None of those are their state's healthiest county. Delaware's internal equity is real. Its absolute level of health, even in its strongest county, still has meaningful ground to close.
There's one number in this report that doesn't fit the story Delaware tells about itself. The state's median household income is $79,129, nearly $14,000 above the national average. Its child poverty rate is 20.0%, slightly above the national 19.4%. A state richer than most of the country has more children in poverty, proportionally, than the country as a whole.
Those children are already in the pipeline for the cardiovascular burden Delaware currently manages at $1.75 billion a year in prescription drug spending. The system that will receive them is well-run. The Medicare acceptance is high, the checkup rates are among the best in the country, and the telehealth infrastructure is built. None of that changes what those children are eating, or where they live, or what their parents can afford.
Delaware has solved access. That was the foundation, and it's a genuine achievement. But a state this small, this wealthy, and this strategically located, incorporated into the legal architecture of American medicine while ranking 45th in clinical trials, is making a choice about what it wants to be good at. Right now it's very good at treating the disease it has. The question is whether it's willing to invest in preventing the disease its children will have.