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CAM back in the Swiss basic health insurance system

The medical practice of homeopathy, Traditional Chinese Medicine, anthroposophic medicine, herbal medicine and neural therapy, which was previously struck off the state insurance list, will be reimbursable from 2012 as part of a six-year trial period.

Back in 2005 the government rejected these complementary (CAM) therapies, arguing they failed to meet the legal requirement of scientific evidence of the three criteria of efficacy, cost-effectiveness and suitability. These three criteria to accept a therapy in the list for reimbursement, are required by the law.

The reversal in policy follows a nationwide vote in 2009 in which two-thirds of Swiss backed expanding the Swiss Federal constitution by an article stipulating that the Federal government and cantons shall ensure that, within the scope of their jurisdiction, complementary medicine is taken into consideration.

As far as the cost-effectiveness of these therapies are concerned, data published in an article in the Swiss Medical Journal* show that even though consultations with doctors who have an additional qualification in homeopathy or other complementary therapies are significantly longer than those in conventional medicine - and leading to a higher patient satisfaction - the total costs per patient per year are not higher and the costs per doctor per year are even 29% lower than in conventional medicine.

The economic benefit of these therapies may have been sufficiently demonstrated, but the health authorities are not yet convinced of the efficacy of the complementary therapies. A federal commission in December 2010 even recommended to strike them permanently from the list because of a 'lack of scientific evidence'. Nevertheless the government has given the medical CAM associations some respite. The associations will have to present conclusive evidence for the efficacy of the complementary therapies by 2017, thus leaving them some time to fill in the gaps for those therapies that so far have not, or only partially, managed to fully meet this requirement.

The evidence is then to go before a recognised international institute for an independent scientific assessment. That institute could be the National Center for Complementary and Alternative Medicine in the USA or the National Institute of Clinical Excellence in the UK.

The government’s decision also includes provisions to boost research and training in the field, which would not be counter-productive, even if there is a negative result for the therapies after the trial period.

 

* the article in the Swiss Medical Journal - Schweizerische Ärztezeitung  is available here, in German only.

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