Out of Pocket Costs and Affordability of Australian Eating Disorder Medicare Benefits Scheme Services Using Linked Data
Author(s)
Natasha Y. Hall, PhD.
Health Economics Group, Monash University, Melbourne, Australia.
Health Economics Group, Monash University, Melbourne, Australia.
OBJECTIVES: Eating disorders are costly to both society and individuals experiencing them. Medicare funded eating disorder treatment in Australia was expanded in 2019, with the aim to alleviate some of the out-of-pocket (OOP) costs and improve access to care. This study aims to determine the out-of-pocket costs and understand the affordability of these eating disorder services.
METHODS: Services Australia mailed out an invitation to 27,658 individuals to participate in an online cross-sectional survey to all individuals aged 15 years or older who had received at least one eating disorder service since 2019. The survey comprised questions designed to understand the costs and affordability of treatment. Medicare Benefits Scheme (MBS) data linkage was obtained from Services Australia for consenting individuals to determine median OOP costs.
RESULTS: 2,421 (8.8% response rate) individuals completed the survey. Of these, 1,959 (81%) consented to linking their MBS data. OOP costs associated with psychological treatment were: mean $60 (SE 0.24), median $33 (IQR $20-$100) and OOP costs associated with dietetic treatment were: mean $51 (SE 0.36), median $29 (IQR $19-$79). Many participants reported ceasing psychological (47%) and dietetic (33%) care early due to the fee being too expensive. OOP fees were considered too expensive at $934 for psychological services and $480 for dietetic services. The most disadvantaged cohort were more likely than other cohorts to pay nothing for psychological (12% for most disadvantaged and 6% for least disadvantaged) and dietetic treatment (27% for most disadvantaged and 9% for least disadvantaged).
CONCLUSIONS: The fee associated with Medicare psychological and dietetic treatments was a factor in early cessation of treatment for many with eating disorders. Regular review and containment of consumer costs, via subsidies, are required to continue to provide affordable and equitable care. Reassuringly, individuals in the most disadvantaged group were more likely to have fully subsidized services.
METHODS: Services Australia mailed out an invitation to 27,658 individuals to participate in an online cross-sectional survey to all individuals aged 15 years or older who had received at least one eating disorder service since 2019. The survey comprised questions designed to understand the costs and affordability of treatment. Medicare Benefits Scheme (MBS) data linkage was obtained from Services Australia for consenting individuals to determine median OOP costs.
RESULTS: 2,421 (8.8% response rate) individuals completed the survey. Of these, 1,959 (81%) consented to linking their MBS data. OOP costs associated with psychological treatment were: mean $60 (SE 0.24), median $33 (IQR $20-$100) and OOP costs associated with dietetic treatment were: mean $51 (SE 0.36), median $29 (IQR $19-$79). Many participants reported ceasing psychological (47%) and dietetic (33%) care early due to the fee being too expensive. OOP fees were considered too expensive at $934 for psychological services and $480 for dietetic services. The most disadvantaged cohort were more likely than other cohorts to pay nothing for psychological (12% for most disadvantaged and 6% for least disadvantaged) and dietetic treatment (27% for most disadvantaged and 9% for least disadvantaged).
CONCLUSIONS: The fee associated with Medicare psychological and dietetic treatments was a factor in early cessation of treatment for many with eating disorders. Regular review and containment of consumer costs, via subsidies, are required to continue to provide affordable and equitable care. Reassuringly, individuals in the most disadvantaged group were more likely to have fully subsidized services.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD45
Topic Subcategory
Distributed Data & Research Networks
Disease
SDC: Mental Health (including addition)