Economic hardship was reported by 97% of patients and families.
Reprinted from Eating Disorders Review
January/February Volume 26, Number 1
The economic burden of treatment is one of the many hurdles patients with eating disorders and their families must overcome. A new report from Australia offers new information about the economic burden faced by patients with eating disorders and their families. In Australia, the cost of treating an episode of anorexia nervosa (AN) is second only to the cost for cardiac bypass surgery, and the overall cost of eating disorders, including treatment, lost production and loss to society was $69 billion in 2012.
While the direct costs for most health care services are either fully or partially underwritten, limited availability of specialist services for treating and managing eating disorders forces many patients and their families to seek private treatment. Families also have economic and social consequences related to changes in education, employment, and to family members who provide necessary but unpaid informal care for patients. Lack of adherence to treatment is also affected by lack of drug coverage, for example, for antidepressants and antipsychotics for comorbid psychological conditions.
The first-ever study of economic burden in Australia
Dr. Lauren Gatt and a team at the George Institute for Global Health, University of Sydney, Australia, used an opt-in invitation and a study questionnaire posted to all persons who had been treated at two hospitals during January 2009 to March 2011, and sent possible participants a link to an online version of the study documents (BMC Psychiatry 2014; 14:338). Patients currently in treatment were also invited to participate and either self-administered a study questionnaire or completed it with the help a researcher. The primary outcome was the household economic burden of eating disorders based on out-of-pocket expenditures on medical and health-related expenses, household economic burden and the related cost of non-adherence to treatment. Hardship was measured using a series of questions about financial stress, such as failure to pay living and medical expenses, and spending more than income by depleting savings or borrowing to finance the expenses.
Ninety persons completed the questionnaires. The majority (54.4%) had self-reported diagnoses of AN (purging or restrictive subtypes), 16.% had bulimia nervosa (BN), and 28.9% were diagnosed with either binge eating disorder (BED) or eating disorder not otherwise specified (EDNOS). Although gender was not a basis for exclusion, 99% of respondents were female.
The economic burden was highest for those with BN
Economic hardship during the prior 12 months affected 97% of study participants, and all groups of patients were affected. The greatest financial stress involved paying for medical appointments (44.5%), followed by dental appointments (44.3%), utility bills (29.5%), and food costs (25%). Most of the families used their savings (61.4%) or sought help from family and friends (45.3%) to pay for treatment. Not adhering to treatment because of cost was most common among those with AN or BN.
Patients with a diagnosis of BN spent twice the amount of out-of-pocket money during the prior 12 months than did those with a diagnosis of AN ($3175 vs $1525, respectively). Hospitalization costs were the greatest for all patients, followed by psychologist and counseling appointments. Overall, families spent 20.7% of their income on treatment for the eating disorder.
The authors point out that unlike the situation with other chronic medical conditions, the current model of care for patients with eating disorders in Australia is outside the primary health care setting and includes a mixture of specialist eating disorder programs, most of which are offered in private settings. Private health care insurance policies will pay for inpatient care but coverage outsider that setting is variable for services in outpatient or day care programs. Thus patients who seek outpatient care tend to have a greater financial burden.
An effort to improve the situation
Dr. Gatt and her colleagues note that the results of their study show that current models of funding for treating eating disorders often limit treatment options beyond admission for severe acute episodes. The study findings may also underrepresent those with poorer outcomes who may be less likely to participate in research. However, there may be good news on the horizon. The Australian National Framework for Eating Disorders has called for development of a sustainable and integrated service model and as part of this a review of Medicare coverage and private health care insurance, to better support patients with eating disorders.