THE COST OF RECOVERY
Eating disorders take a large toll on both the psychological and physical wellbeing of the individual. However, this is not the only price one suffering will have to pay. One must pay a substantial cost to recover and move past the illness.
The Financial COst
Many aspects contribute to the total cost of eating disorder treatment (it also varies depending on the type of eating disorder). In most cases, one will have to pay for psychological therapy, nutritional therapy, intensive outpatient programs, partial hospitalization programs, residential programs, inpatient hospitalization, medication, and more. Altogether, treatment without insurance can cost upwards of $30,000. On average, patients stay at residential centers (a program that provides 24-hour care to medically stable patients who need more support than outpatient programs) for 50 days. Still, this number can quickly increase depending on the severity and type of eating disorder one has. Without insurance, these centers can cost upwards of $2,000 daily, with the total cost depending on the amenities offered and treatments needed. This is only one step suggested by doctors in the overall recovery process. Medically unstable patients may need to be admitted to an inpatient hospital. A stay at an inpatient hospital lasts an average of 14 days, making the total cost without insurance adding up to $19,400. Despite the hefty price, inpatient hospitalization only provides physical care, not psychological. One option that many opt for in order to receive said psychological support is to enroll in an intensive outpatient program (a structured program either online or in person for patients who do not need 24-hour support; these programs tend to last for several hours a week for seven days a week). An outpatient program can cost anywhere from $250-$350 per day. Partial hospitalization programs (commonly used by patients who need the physical and psychological provided by inpatient hospitalization but are stable enough to sleep at home) are another option for patients, with the average cost ranging from $350-$450 per day without insurance. Many patients will hire a therapist and dietician after completing outpatient programs, partial hospitalization programs, residential programs, and inpatient hospitalization. Luckily, the mental health parity law requires insurance to provide mental health benefits similar to the ones they provide for physical conditions. Without insurance, though, a one-hour therapy session for an eating disorder can cost anywhere from $100-200. Regarding dietician prices, paying out of pocket can cost upwards of $100 per session. These numbers make the cost of psychiatric medications for eating disorders look like spare change, with the out-of-pocket cost being upwards of $25 for a month's supply. Over 28.8 million Americans have or have had an eating disorder,
The Problems of the price
While there are cheaper options to take for those who are unable to afford intensive treatment, many healthcare providers do not even suggest them when providing treatment options to patients. This brings up another issue: corruption of eating disorder services within the healthcare system. Many recovery centers attempt to sway doctors by incentivizing them to take all-inclusive visits across the country to visit their centers and recommend them to patients. Dr. Adrian Brown, a psychiatrist in Virginia, explained how she was offered a "V.I.P." trip, with the representative explaining, "We will pay your way, put you up in a nice hotel, all expenses paid, yoga and whatever." This is a common occurrence in the eating disorder recovery industry, which only becomes more concerning when one notices the similarities between it and the pharmaceutical industry. Many doctors will quickly deny the influence that the innovations to a "reception with cocktails and hors d'oeuvres" have on which centers they recommend. Still, the abundance of evidence supporting the relationship between doctors who recommend centers after visiting them is undeniable. Author Erica Goode, a New York Times journalist, highlights this by explaining, "Studies had shown that even small gifts from drug companies, like free medication samples, affected doctors' prescription practices." Dr. Angela Guarda explains that most doctors do not have malicious intentions, but even so, it is a "slippery slope" since "money can cloud your view."
The data shown so far has mainly come from American news sources, but eating disorders place an economic burden on individuals across the globe. In 2019, the World Health Organization (WHO) worked alongside the Institute for Health Metrics and Evaluation to draw attention to the gravity of this illness. Their findings are shown in graph on the right. Their results demonstrated that the prevalence of individuals globally who had an eating disorder increased from 8,502,892 in 1990 to 13,634,506 in 2019. To put that into context, the percentage of the global population with an eating disorder increased by 0.16% from 0.18% during those years. As this number has increased, so has the estimated market value of the eating disorder therapy sector. The Globe Newswire reported that the eating disorder recovery market worldwide "accounted for US$457.6Mn in 2020" and estimates the market to be worth "US$763.8Mn" in 2030.
Moreover, they anticipate the market to "register a CAGR of 5.3%." With the prevalence of the illness and market value increasing, the incentive for investment in the industry grows. This places an ethical burden upon the investors, leaving them to decide whether they invest their money into helpful or hurtful services in this industry.
The Ethical Cost
The cost of eating disorder treatment brings up a much larger ethical concern: the relationship between income inequality and accessibility to health services. Patients who come from lower or middle-class households are often faced with prohibitive costs that prevent them from receiving the treatment they require. The disparity present here presents an ethical problem regarding the equality of the healthcare system. The fact that the financial status of an individual is the determining factor of the quality of care they receive shows a failure of the global healthcare system. The ethical imperative to ensure equitable access to recovery is evident in theory but has yet to be carried out.
Classifying the Problems
The extensive treatment costs and financial barriers to recovery can be classified as a collective action issue. A collective action problem, as defined by Brittanica, occurs when "a number of people work together to achieve some common objective." The origins of this issue stem from the fact that while the group may share a similar goal, each individual has their own, sometimes conflicting, interests. In terms of the eating disorder industry, organizations may share a collective goal of providing healthcare and treatment to patients with eating disorders. However, their desires may conflict with aspects such as moral values and ethics. When individual healthcare providers oversure shared resources (i.e., insurance funds) by emphasizing the expensive treatments (regardless of their efficacy) they are being paid to do, it becomes a tragedy of the commons. All this does is increase healthcare costs and deplete resources for needy individuals, leading to suffering for those who are paying rather than profiting. This scenario also presents a free rider problem, which could be solved by instilling better regulatory frameworks and public health care funding.
Conclusion
Regardless of the viewpoint one takes on recovery, every individual aware of the problem must advocate for those recovering from an eating disorder. Raising awareness of issues such as high treatment costs and systematic barriers that restrict much-needed care can lead to the formation of solutions. Advocacy within a healthcare system driven almost entirely by profit is difficult, but those who acknowledge it is wrong should also act upon said knowledge. After all, healthcare should not be centralized upon financial gain but instead on the wellbeing and equal treatment of recovering individuals.