News – New regulation found after the CAMbrella deliveries:
No new regulation found.
Notice! All text below is copied from the CAMbrella report – delivered Dec 31, 2012
In this summary, you will find:
- Direct links to the legislation of specific CAM therapies in Germany
- The legal and regulatory status of CAM and CAM practices in Germany
- The governmental supervision of CAM practices in Germany
- The reimbursement status of CAM practices and medicinal products in Germany
Go directly to legislation of specific CAM therapies in Germany:
Acupuncture – Anthroposophic medicine – Ayurveda – Chiropractic – Herbal medicine/Phytotherapy –
Homeopathy – Massage – Naprapathy – Naturopathy – Neural therapy – Osteopathy – Traditional Chinese Medicine (TCM) – Other treatments
The legal and regulatory status of CAM and CAM practices
CAM given by non-physicians has been legally regulated in Germany since 1939 by the
passing of the “Heilpraktikergesetz” (HeilprG), which also established the protected title
“Heilpraktiker” (120, 121). According to the Heilpraktiker act practitioners of homeopathy must be registered after passing an exam administrated by local healthcare authorities in order to prove that they possess sufficient knowledge in medicine and healthcare legislation (50, 121).
The HeilprG states among others that:
- §1 Whoever wants to practise medical treatments without being accredited as a
medical doctor needs a special permission.
- §2 Medical science/treatment in the meaning of the law is every kind of activity,
which is practised as a profession, directed at diagnosing, treating or relieving
illnesses, sicknesses, or disabilities in humans, also if they are practised in the service
- §3 A person who has practised medical science/treatment at a professional level up
to date and plans to continue to do so, will receive permission in accordance to the
rules of the implementing regulations (121).
In order to practise medicine or carry out specialty training in Germany, all physicians must be in possession of a valid full or temporary licence to practise (122). The
“Bundesärztekammer” offers additional certificates in some CAM treatments, so called
”Zusatzbezeichnungen”, treatments are naturopathy, acupuncture, homeopathy, manual
medicine , physiotherapy.
Only medical doctors and Heilpraktikers (non-medically qualified practitioners) are allowed to provide CAM treatments, but there are restrictions on the performance of particular medical acts (28, 41). Only medical doctors are allowed to treat sexually-transmitted, communicable and epidemic diseases, deliver specific medications, give or provide anaesthetics and narcotics, practise obstetrics and gynecology, take X-rays, perform autopsies and issue death certificates (28, 123).
A Heilpraktiker(non-conventional health practitioner) must meet certain criteria, pass a
public exam and register in order to get the licence to practice (41). According to the
HeilprG, implementing provisions §2 (120), permission is not granted:
- If the applicant has not yet reached the age of 26 (a).
- If he/she does not have German citizenship (b).
- If he/she cannot prove at least completion of primary education (d).
- If it appears that he/she lacks moral reliability, especially heavy criminal or ethical misconduct(f).
- If, in terms of health he/she is unfit to practise (g).
- If it can be assumed with certainty that he/she is practising medicine in addition to any other profession (h).
- If a review of the knowledge and skills of the applicant by the Health Department indicates that the practice of medicine by the person would mean a danger to the Public Health (i).
Acupuncture, anthroposophic medicine, homeopathy and naturopathy are legally regulated as therapeutic systems (28). The Medicines Act have accredited treatment forms in homeopathy, anthroposophy, and phytotherapy in a special law called “Besondere Therapierichtungen“, “Special treatment directions” (124).
The governmental supervision of CAM Practices
The medical associations focus on regulation of the professional practice and specify
requirements for CME training, the professional code of conduct and routines for
accusations of medical malpractice (125). Breach of regulations for treating patients may
result in penalties (28). The health insurance companies are supervised by the state (125).
The reimbursement status of CAM practices and medicinal products
The statutory health insurance system (SHI) (since 2009 funded by the “Gesundheitsfonds”) manages the covering of health care services in Germany. Physicians must be approved and registered as “SHI physicians” to bill the statutory health insurance companies for treatment of patients (125).
The state insurance companies reimburse partly acupuncture (only for chronic knee pain due to osteoarthritis and for chronic low back pain), homeopathic and anthroposophic treatment performed by contracted (SHI) qualified medical doctors, but patients must pay for medicines (41, 106, 125). Anthroposophic medicine is also reimbursed by private insurance companies (106). Some private insurance companies cover homeopathic remedies and acupuncture (106).
The health insurance will pay the costs for normal physiotherapy sessions, but most likely the patient will co-pay for the osteopathy part of it.
From 2012 a new law (GKV-Versorgungsstrukturgesetz)(126) came into effect. The law
allows the statutory health insurances to offer additional benefits to its customers. E.g. the Technical Krankenkasse (TK) decided to take over costs of up to 100€ per year and per insured person for homeopathic, phytotherapeutical and anthroposophic medicinal products which are obtainable only in pharmacies, but without a prescription.