Tuesday, November 25, 2008

The recent NJ decision was mentioned over at ED Bites and while I am glad for the families involved and those it will effect positively, I do have to say I have somewhat of a differing opinion about what the actual decision means.

For Families across the nation, paying for healthcare is both a fear and a struggle. With the costs of modern medical and mental health treatment, many middle class families can no longer afford to “get sick,” but what happens when somebody needs expensive longer-term care? With epidemic status, eating disorders afflict people regardless of age, race, class or gender. Eight million American’s face a daily struggle, and are more than not, denied the help they need by managed care providers (ANAD, 2008). Anorexia, once known as a “rich white girl’s disease” appears in every demographic and with the highest mortality rate of any mental illness, still only one in ten sufferers receive treatment and even less receive adequate treatment (South Carolina Department of Mental Health). Inpatient care averages at approximately $1,000 per day and with an average length of stay falling somewhere between three and four months, even middle class families are facing debilitating financial struggles to give their loved ones the care they need (Costin, 1999).
In Critical Care (Bennett, 2008), Bennett highlights several families with a member struggling with Anorexia Nervosa , and reviews the complications of receiving the costly treatment proven to produce positive results. Bennet further delves into the complications of cost, length of stay and ultimately the managed care that many American families rely on. As an example, the author highlights a class action lawsuit in which over 100 US families of eating disorder sufferers sued Aetna for inadequate coverage or in most cases, lack of coverage all together. Aetna’s argument was that in most states, managed care is only required to cover biologically based disorders and as the research has no conclusive evidence as to whether Anorexia is biologically based.
It touches on issues of mental health parity and its insuffiency or lack of existence in many states in the nation, but the average reader would have to do further research to understand the implications of parity and associated diagnoses. While three pages hardly affords Bennett the space to portray the complications Anorexia provide, she mentions the sheer time it takes to gain weight at two pounds a week, a speed generally considered healthy. Bennet further goes on to explain the settlement Aetna proposed and its insuffiency when compared with the lack of benefits and funds spent by the individual families.
In the article, Bennett introduces a recent policy initiative called the FREED act, which would “implement research and education initiatives, as well as require employers and insurers to cover eating disorder treatment the same way they cover physical disorders.” (Bennet, 2008). She further highlights two more bills aimed at New Jersey state brought about by senator Joseph Vitale, the first of which would add eating disorders to the list of mandated covered mental illnesses and the second would define them as biological.
One could glance at these initiatives and assume they would fix the problem of funding for a population so desperately in need, but they would miss out on the mass population of eating disorder sufferers. According to state parity in California and most states that, infact, have Parity for eating disorders, insurance companies are not required to cover the most common eating disorder, ED-NOS. (Harlick, 2006). Defined in the DSM-IV loosely, it applies to those who for one factor of another do not fit into the criteria for Anorexia Nervosa or Bulimia Nervosa. For example, an emaciated woman who fit all the diagnostic criteria for anorexia, but still had her menstrual cycle (either because she was on birth control or naturally) cannot technically have an anorexia diagnosis, as amenorrhea is a diagnostic criterion. A man, who threw up everything he ate, but did not eat more than any typical person in his situation beforehand, cannot technically have bulimia. These examples compose a vast majority of sufferers and Parity does nothing for them, other than to make them feel like they don’t deserve help (Lipton, 2008). Furthermore, the act proposed by Senator Vitale, while immediately helpful for those with Anorexia or Bulimia (as defined by the DSM-IV), has long-term ramifications that may be detrimental. If one classifies an intersectional disorder as biological, purely for immediate relief, they risk sacrificing much funding for experts to study the true nature of these disorders, which may lead to more accurate of comprehensive care down the line.
While policy surrounding eating disorders is lacking and often leaving sufferers and their families “out to dry,” policy initiatives need much more backing by the experts themselves and a holistic view would craft bills that help all those who suffer. With bills that effect only a small few, the oft question echoes in reverse, not “Can you afford to eat?,” but rather, “Can you afford not to?”

Citations:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental
disorders (4th ed.). Washington, DC: Author.
ANAD, Anorexia Nervosa and Associated Disorders Facts about eating disorders.
Retrieved September 18, 2008, Web site: http://www.anad.org/22385/index.html
Bennett, Jessica (2008). Critical care: Why even families with health insurance are
resorting to lawsuits to get coverage for the treatment of eating disorders like anorexia.. Retrieved Sept. 16,2008, from http://www.newsweek.com/id/142988/page/1
Costin, C (1999). The Eating Disorder Sourcebook.
Los Angeles: Lowell House.
Harlick, J (2006). Food fight: People suffering eating disorders have precious few
resources in the bay area. Retrieved Sept. 16,2008, from http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/01/06/PNGQEGF2TO1.DTL&type=printable
South Carolina Department of Mental Health, Eating Disorder Statistics.
Retrieved September 18, 2008, Web site: http://www.state.sc.us/dmh/anorexia/statistics.htm

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