The Politics of Eating Disorder Treatment

Institutional health care--hospitals, rehabilitative centers, nursing homes and outpatient clinics--has undergone a transformation in the last decade from independent entities to large business. In order to have bargaining power in the marketplace with health insurance companies, institutions had to merge and garner a significant market share in their local community.

The most concerning issue with large health care business is consistent quality of care. Executives have increasingly relied on evidence-based medicine as the standard of care to show how even large institutions can provide excellent clinical treatment at all of their medical sites. 

This sea change in medical practice--large business and evidence-based medicine--has skipped mental health care which continues to exist in a world of solo practitioners and treatment centers. In fact, mental health treatment has often remained independent of the health insurance industry as well, except for the poor, the disabled and people with eating disorders.

As the spread of eating disorders breaches socioeconomic boundaries, too many patients don't get adequate care due to insurance limitations. And independent entities--clinicians or residential programs--have no purchase to bargain with health insurance companies. 

The new business model for the health care industry finally appears to be coming to the eating disorder treatment world. The Affordable Care Act provides one boon to the transformation: federal parity for mental health treatment. Any plan under the ACA must offer equal coverage for medical and psychiatric care, including treatment for eating disorders. Thus, one major bargaining chip for the insurance industry to limit care is no longer viable. 

The current trend is for well-known eating disorder programs to franchise residential and outpatient treatment centers in parts of the country with fewer resources. But eating disorder treatment remains complex and doesn't have evidence-based guidelines that are widely accepted. Finding any effective treatment is hard enough.

Instead, franchises attempt to replicate treatment through modeling and mentoring. Programs design step-by-step guidebooks to establish a new program while the program director or experienced clinicians train the employees at the new center. Sometimes, the director of the new center may actually move from the original center to start the new franchise. 

Eating disorder treatment remains long and hard without new scientific breakthroughs on the horizon. Expensive care for the chronically ill weighs heavily on the bottom line for health insurance companies so limiting care remains a cornerstone for minimizing financial outlay. This current system creates an underclass of people with chronic eating disorders and no way to find a path to recovery. A passionate group of directors of nationwide treatment centers can lobby government and insurance companies to offer adequate care for this languishing population. 

I see how noble this mission truly is. The rise in the incidence of eating disorders in recent decades, as I have chronicled extensively in this blog, is due to a combination of pressure for thinness, sedentary lifestyle, the rise of processed food and sanctioned starvation as a weight loss technique. But society has struggled to take responsibility for our self-inflicted epidemic.

Those unfortunate enough to have become ill labor for recovery in secret while everyone else marvels at what appears to be an incomprehensible illness. Making the suffering of these people public will hopefully force government and the health insurance industry to create fair and adequate treatment available to patients with eating disorders.

The parity for mental health care in the ACA and the increased potency of a centralized eating disorder treatment industry might just pack enough punch to make an impact.