Q & A: A Medical Care Dilemma

Q: The father of one of my patients has expressed concern about ongoing medical care costs for his young adult daughter, who is now reasonably well recovered from her initial episode of anorexia nervosa (AN). But, shes not all better. Hes trying to think ahead about insurance and out-of-pocket medical costs. Is any information available that might help guide him in his decision? (B.B., Houston, TX).

A: With respect to these concerns, this father certainly has lots of company. Unfortunately, little research has specifically addressed this issue, and the data that do exist suggest that significant medical costs will be an ongoing concern for this family. Statistically, of course, many eating disorders are recurring conditions, and individuals who have had adolescent eating disorders are at higher risk for subsequent physical as well as psychiatric morbidity (Arch Gen Psychiatry 2002; 59:545-52). More recently, Mitchell et al. studied 322 patients with assorted eating disorder diagnoses and followed their healthcare costs from 2000 to 2005, compared to 224 patients with depression and a control group of 6,866 individuals with no eating disorders who were enrolled in a Blue Cross-Blue Shield health insurance plan. Taking hospital and clinic, healthcare provider and medication costs into consideration, they found that patients with eating disorders, on average, had sustained healthcare costs resembling those of patients diagnosed with depression, often a chronic psychiatric condition. Patients with eating disorders not otherwise specified (EDNOS) averaged the highest costs, closely followed by patients with bulimia nervosa. Health-care costs for patients in both groups averaged somewhat over $6,000 per year. The small sample of patient diagnosed with AN had the lowest costs among the eating disorders groups, but costs were still significantly higher than for the control group (IJED 2009; 42:571-574). If healthcare reform passes, your patients and their families may be able to take some comfort in the fact that pre-existing conditions may not be grounds for exclusion. Nevertheless, on average, they can anticipate ongoing healthcare costs that may prove to be consequential.

— J.Y.