Delaware dropped four spots in The Commonwealth Fund's 2018 Scorecard on State Health Performance released on Friday.

Delaware ranked 22nd in measures such as access to health care, efficiency of care, quality of care, health outcomes, income-based health care disparities. The number of deaths by suicide, alcohol or drug abuse jumped from 38.2 deaths per 100,000 population in 2013 to 49 deaths per 100,000 in 2016.

A report from the United Health Foundation, released earlier this year, ranked Delaware in 30th place. The report pointed to higher than average rates of drug deaths, cancer deaths, obesity rates, diabetes and violent crime offenses.

The combination of rising costs and lowering outcomes has left Delaware searching for answers.

"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 (DHSS) Secretary Dr. Kara Odom Walker.

Gov. John Carney signed a bill in September authorizing the creation of a health care spending benchmark to shed light on how health care dollars are spent. Gov. Carney also signed an executive order in February creating an advisory group to help Secretary Walker create spending and quality benchmarks for the state.

"Across the health care spectrum, our goal is to examine health care costs and how to slow the growth of those costs, while improving the overall health of Delawareans at the same time," Secretary Walker said. "The Commonwealth Fund rankings provide us with valuable insights into the areas where we need improved health outcomes."