Public Insurance May Preclude Recommended Treatment for Eating Disorders

In the United States, young patients with public health insurance were found to be less likely to receive recommended treatment for eating disorders than patients with private insurance. These findings were published in the Journal of Eating Disorders.

Investigators from University of California, San Francisco retrospectively reviewed patient charts collected between June 1, 2012 and December 31, 2019 for youth and young adults (N=1060) ages 11-25 years who presented with malnutrition secondary to disordered eating. Receipt of recommended treatments within 6 months of initial evaluation was assessed on the basis of insurance type and patient characteristics.

The study population comprised patients with a mean age of 16 (standard deviation [SD], 3) years, 85.7% were girls or women, 54.5% were White, 17.7% were Latinx, and 22.2% had a prior hospitalization.

The most common diagnosis found among the patients was anorexia nervosa (38.4%), followed by unspecified feeding or eating disorder (27.6%), atypical anorexia nervosa (13.3%), avoidant restrictive food intake disorder (6.1%), bulimia nervosa (6.1%), other specified eating disorders (5.5%), and binge eating disorder (1.6%).

Overall, 249 patients were covered with public insurance and 805 with private insurance. Participants in the public insurance group were younger, fewer were girls or women, were White, and spoke English compared with participants in the private insurance group (all P ≤.001).

Of those who followed up, 359 patients did not receive their recommended treatment. Predictors for receiving treatment included ethnicity (χ²=53.28; P <.001), spoken language (χ²=40.49; P <.001), insurance type (χ²=69.28; P <.001), diagnosis (χ²=48.48; P <.001), and history of hospitalization (χ²=20.97; P <.001).

Patients with a history of hospitalization were nearly twice as likely to receive recommended treatment (adjusted odds ratio [aOR], 1.96; 95% CI, 1.32-2.94; P <.001) as those without. Those with private insurance were 3 times more likely to receive recommended treatment than those with public insurance (aOR, 0.31; 95% CI, 0.17-0.59; P <.001). In addition, patients with a diagnosis of “other” were half as likely to receive recommended treatment as those with anorexia nervosa (aOR, 0.41; 95% CI, 0.28-0.59; P <.001). Those who identified as racial or ethnic minority were less than two-thirds as likely to receive recommended treatment compared with those who identified as White (aOR, 0.63; 95% CI, 0.45-0.89; P =.008). The researchers also found no significant correlation between racial or ethnic minority status and insurance type (P =.68).

Among the subset of Latinx patients, individuals with a history of hospitalization were more likely to receive recommended treatment (aOR, 4.33; 95% CI, 1.52-12.20; P =.006) than those who were not. Furthermore, those with a diagnosis of anorexia nervosa were a staggering 14 times more likely to receive recommended treatment than those with atypical anorexia nervosa (aOR, 0.07; 95% CI, 0.01-0.62; P =.017). Those with “other” eating disorder were one-third as likely to receive recommended treatment (aOR, 0.31; 95% CI, 0.10-0.99; P =.048).

The findings of this study may not be generalizable for patient characteristics in other areas.

Study authors concluded, “There are multiple structural barriers to equitable eating disorder care for adolescents and young adults. Publicly insured youth with eating disorders have limited access to evidence-based psychological treatment. Youth of color are less likely to be diagnosed and receive recommended treatment, even after adjusting for demographic and clinical characteristics.”