Is Maudsley cheaper?

Cindy, a friend in the DC area whose son has anorexia, alerted me to today's Wall Street Journal, "Eating Disorders: Families Fight Back: Insurers Have Long Covered Only a Fraction of Huge Costs; Now, Pressure to Pay More" by Elizabeth Bernstein.

I am grateful to all the work out there to get eating disorders covered by insurance. Parents are forced to desperate measures to get treatment - financial ruin on top of the heartbreak and disabling illness.

But as a passionate advocate for family-based treatment, I worry.

The medical and psychiatric community needs to treat eating disorders as the neurobiological illness they are. Eating disorders are real diseases, not choices.

But the $1-2K daily cost of inpatient treatment isn't necessarily the thing I want them to pay for.

1) I'd like to see the day when no one diets or overexercises in the first place, triggering the physical imbalances which create eating disorders. Spend money educating the public about the danger (and futility) of dieting. Spend money on early detection. Save medical care dollars by educating coaches and pediatricians on detection and intervention.
2) I want insurance companies to STOP PAYING for treatments without scientific basis. Equine therapy, psychoanalysis, and individual psychotherapy for children come to mind. Might also want to take a close look at the failure rates of the treatment centers out there -starting with the ones who use unscientific methods to advertise their 'success rates.'
3) Maudsley therapy isn't free, but home-based treatment is less expensive, shorter in duration, and with a better success rate means less expense over time. Pay for early intervention with evidence-based care which trains the CAREGIVERS, not the sufferer, to provide guaranteed nutrition and an emotionally safe environment.

Inpatient treatment has its place. Families with limited resources need emergency respite and adjunct care. Safety has to come first, and no home should be safe harbor for eating disordered behaviors.

Finally, I challenge inpatient treatment programs to start treating the family as part of the treatment from the beginning - not for a condescending 'family week,' but integrated into the treatment team from the beginning through discharge and after care. The UC San Diego program model, and the Boswell Center in Jacksonville both operate in this way.

Am I terrified that insurance companies will discover Maudsley and use it as a way to pay even less, and put the burden back on under-equipped families? Yes. But I can't let that fear cloud the issue: sufferers deserve early intervention with effective methods. Families deserve coverage for what works, and what will prevent years of disability and poor outcomes.

A false choice is peddled to vulnerable parents: ineffective outpatient treatment versus parentectomy. The real choice needs to be: effective outpatient support or effective inpatient support.


  1. And as you know one of MY big bug bears is that both Insurance Companies and Cash Strapped Health Care Systems will be attracted to Maudsley just because, when families DO manage to do it on their own, it is a lot cheaper in £££s or $$$s even though effective, intensive, long term support to help ALL families do it is going to cost a LOT more than most of them are prepared to put in.

  2. And I do know that this shouldn't put people off campaigning for these evidence based treatments to be widely available, on the contrary they should be made available to ALL and that will mean giving MORE resources to them in order that families who have extra difficulties (James Lock's 25%) can succeed too.
    One difficulty is that in order to make their word known, even the best treatment providers have to put money into "advertising" whether that be in desining pretty websites or attending medical conferences and that money is then lost to treatment and research - oh well, it isn't a perfect world.

  3. when you say to eliminate psychoanalysis, do you mean the freudian practice or therapy in general? i feel as if it would be detrimental to some sufferers if they were unable to get insured therapy-specifically the ones who act out on symptoms due to school pressure, family issues etc.

  4. "when you say to eliminate psychoanalysis, do you mean the freudian practice or therapy in general?"

    I'm a fan of brief, results-oriented, psychotherapy for adults (along with full nutrition). I am not a fan of psychoanalysis.

  5. Met with my daughter's therapist today, who said that our HMO is moving toward a Maudsley approach. Great, I said, then noticed that she looked upset. She has the same concern about insurance companies seeing maudsley as a cost savings measure, and reason to believe that they do see it that way.

    I think maybe the key is emphasizing Stages 2 and 3 of Maudsley, so insurers don't see it only as a cheap way to refeed anorexics. They still have to commit to dollars for therapy, especially in stage 2. Now that my d's been weight recovered for a number of months, she is finally in a mental place to benefit from therapy. I hope the HMO covers it.

  6. I'm in public health, as well as being in recovery from anorexia. Though I am a young adult and recovery technically "on my own" I am doing so with much parental support. I know that refeeding is key. If my child ever got ill with an eating disorder, I would use Maudsley first.

    I guess my question is not that insurance should cover home refeeding because it's cheaper, but because it WORKS. I realize you said that, but the title of the post...erm. Here's where the public health comes in: most of the increase in lifespan in the last century has been from relatively cheap public health efforts- flouridation of water, vaccines, etc. NOT from MRIs, CAT scans and the like.

    Should insurance pay for vaccines? Absolutely. But not because they're cheap. Because they WORK. I do realize that's what you said about Maudsley, but I guess I had to put my two cents in.

    As well, to me, the first line of care should be evaluation by a competent, qualified and caring professional to determine what level of care is needed. That alone would go a long way!

    Cheers to you and the work you do.


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