Health care reform and eating disorders
I was out to coffee with two of my friends from DC this morning (L was visiting me, C--my very first friend EVER--was home for the weekend, so all us DC peeps were together in the Midwest) and we got to discussing health care reform. Part of it was shop talk of people who live in DC, and part of it was related to C's job at a non-profit advocacy group that works on health care reform. Although I didn't talk specifically about how this would relate to eating disorders--both L and C know about my history and current relapse--I did think about it.
A little while ago, I read a new paper from the International Journal of Eating Disorders titled "Service users' views of eating disorder services: An international comparison" that really seemed to drive home many of the conundrums I think about with respect to both health care reform and eating disorders. In this debate, the UK's National Health Service is either held up as a good example or how Satan would provide health care, depending on your political persuasion. It is, of course, more nuanced than that, especially in terms of treating eating disorders.
The study concluded the following:
Both samples identified the following as essential aspects of care: good therapeutic relationship, holistic approach, individual psychotherapy/counseling, specialized treatment, client-centered care, and support. In the US sample, the main concerns involved lack of financial accessibility to services and problems with insurance coverage. In the UK sample, lack of and inequity of availability of services were highlighted and three main barriers to accessing care were identified.US and UK service users' views suggest that neither country provides early intervention and comprehensive care for EDs at present, although due to dissimilar health care systems the barriers to care differ.
My own personal opinion is that neither system does a good job of treating eating disorders. The labyrinthine system of insurance coverage and treatment options (most of which aren't covered by insurance) in the US is almost impossible to navigate and just as impossible to pay for. If you have an eating disorder, you rapidly learn the meaning of terms "not medically necessary" and "out-of-network" and how to meet your annual deductible by the third week of January. Options, yes, if you can pay for them, but precious few are evidence-based. In the UK, you face year-long wait lists and draconian criteria for hospitalization. Yes, everyone gets care, if you can survive long enough to get seen.
Both systems have their advantages and disadvantages, but the plain fact of the matter is that we, as a human race, suck at treating eating disorders in particular and mental health issues in general. I don't know of any shining examples out there. No one has all the answers. But I know that some of the answer lies in developing evidence-based treatments and insisting upon their use. Because giving treatment to everyone won't do much good if most of those treatments have no proven efficacy.
6 comments:
The UK's NHS needs a drastic reorganisation. I have relatives who are doctors. I know people who've been trying to get computer system upgrades in place within NHS administration. And I've just heard some absurd stories. There needs to be a complete overhaul of how it's run and managed to lead to cutting both costs and waiting lists.
But we must not get rid of it.
I've been told that America is worse than almost anywhere in the world for having people turn up in the emergency room with problems that would have been minor if caught earlier. There needs to be a system of health care.
Obama has the chance to put thought and planning into a system that's brand new, which shouldn't be lumbered with the problems that have developed in the NHS over the years. America should end up with a system that delivers the best of what the NHS represents without the organisational headache.
My view is that it's about time someone in America did this. If it all works out, maybe the NHS will be able to take a few hints.
The health reform proposals get rid of lifetime maximums, which are particularly relevant for expensive inpatient stays. And guaranteed coverage irrespective of pre-existing conditions. Not bad news for ED's.
My guess is that the comparative effectiveness review pieces won't hit behavioral health services for many years if ever (advanced imaging tests and rx's are in the immediate cross hairs) but you could see some inpatient/day treatment/IOP/home-based care comparisons one day.
I think the NHS is impressive, because it does cover everyone and does so at a lower price. I think, though, the fact that people from all over the world fly in to go to the Mayo Clinic and Boston Children's and a number of other US institutions says something about the quality of our system. And if I had a five year old who needed cancer treatment or a transplant or a complicated orthopedic treatment, I'd want them treated here in the US, not the UK. If we can reform the system to keep that quality while increasing the number of people covered, I'm all for it, but I think it's going to be hard.
If you have money, I think the US is the place to be for eating disorder treatment, although it's hardly perfect. If you don't have money, you might be better off in jolly old England.
Mental Health SHOULD be a top priority. the world would be a better place to live.
i don't know we're so afraid of our real selves. why is there shame in needing help? why is it so often considered weak?
mental health care isn't really a luxury. but some treat it that way.
okay, i'm coming off my soapbox
I am totally pessimistic about any real reform happening at all. I expect a very minor tweak and then the right wing, which has deliberately stymied and stalled all efforts at real form, will point the finger at the Democrats, who are too weak to stand up. Sorry to get political but I am really angered by the whole thing.
And given the choice of what we have in the U.S. RIGHT NOW, and the UK's NHS RIGHT NOW, I'd take the NHS hands down. Why? Because have a chronic, pre-existing condition and am thus trapped in my job because if I leave it, or even get laid off, no insurance company will insure me, at least without charging me a fortune. At least in the UK I'd get the necessary care, if not in a luxurious high-end doctor's office.
I just saw this article in my Facebook newsfeed:
http://www.newsweek.com/id/142988
Nothing we don't already know, but still an interesting read.
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