Evaluation of Australia's eating disorder Medicare Benefits Schedule items: Clinical outcomes, predictors of symptom improvement and associated costs.

Abstract

Background: Eating disorders are a public health concern in Australia. In 2019, Medicare expanded publicly funded eating disorder treatment, covering up to 40 psychological and 20 dietetic services annually. This study evaluated service-user experiences and outcomes, identified predictors of symptom improvement and examined treatment costs and affordability.

Methods: Services Australia invited 27,658 individuals aged ⩾ 15 years who accessed Medicare eating disorder services since 2019 to complete a survey. The survey captured demographics, service use, satisfaction, outcomes and costs. Medicare Benefits Schedule data linkage provided objective service use and out-of-pocket costs. Logistic regression identified predictors of symptom improvement.

Results: A total of 2421 individuals (8.8%) responded. Most participants were satisfied with treatment (psychological 71%, dietetic 68%). Retrospective self-reported symptoms improved following both service types. Among respondents, 1959 (81%) consented to Medicare Benefits Schedule (MBS) linkage. Mean out-of-pocket costs per session were $60 (SE = 0.24) for psychological and $51 (SE = 0.36) for dietetic services. Five-year out-of-pocket costs were higher for psychological services (median $876) than dietetic services (median $335), though psychological care was more often considered affordable. Cost contributed to early treatment cessation (psychological 47%, dietetic 33%). Receiving 10-19 sessions (psychological odds ratio = 3.30; dietetic odds ratio = 3.37), ⩾ 40 sessions (psychological odds ratio = 2.64) and greater baseline severity (psychological odds ratio = 16.67; dietetic odds ratio = 25.0) were associated with increased likelihood of symptom improvement.

Conclusion: Medicare-funded eating disorder services were associated with high satisfaction and improved symptoms. However, costs remain a key barrier, contributing to early cessation, despite greater perceived affordability of psychological care. Greater treatment intensity and baseline severity were associated with improved outcomes.