Once on the fringes of the healthcare system, growing public demand for complementary medicine has led to increased regulation in an effort to eliminate bad apples and improve patient safety. It’s the result of a lot of trial and error.
This content was published on April 27, 2020 – 11:00
Even before the coronavirus pandemic became a hot topic, the government of the central Swiss canton of Lucerne was concerned about changing its health law. (Health matters fall under the jurisdiction of the 26 Swiss cantons, which often means a lack of uniformity across the country).
At the beginning of March, a new Lucerne health bill was presented with one main objective: to introduce work licenses for alternative medicine practitioners in the fields of homeopathy, Ayurveda, traditional medicine Chinese and traditional European medicine.
“These practices present a certain health risk for the population. With the introduction of the authorization requirement, the canton of Lucerne wants to ensure that only people who have certain minimum professional skills are active,” Alexander Duss of the health department of the canton of Lucerne told swissinfo. ch.
But such requirements were in place before and were later revoked. In 2006, Lucerne decided to remove previous work license requirements for alternative health practitioners. At the time, there were too many different courses for authorities to check the qualifications of professionals, according to Hanspeter Vogler, head of the canton of Lucerne’s health department.
Ultimately, unable to guarantee consistent quality across the industry, the township decided to leave it up to patients to determine whether their choice of a professional for treatment was the right one or not.
Back in the mainstream
Everything changed in 2009 thanks to the system of direct democracy in Switzerland. That year, two-thirds of Swiss citizens voted for the inclusion of alternative medicine on the constitutional list of benefits covered by health insurance. First incorporated in 1999, they were delisted by the government in 2005 amid rising national health costs using the argument that they failed to meet criteria for effectiveness, profitability and adequacy.
Following the 2009 vote, five alternative therapies – homeopathy, holistic medicine, herbal medicine, acupuncture and traditional Chinese medicine – were included in the basic health insurance package (compulsory for all Swiss residents) as test provided that they are administered by qualified doctors. This move brought alternative medicine back into the fold of mainstream health care. The authorities could no longer afford to ignore it now that it once again represented a share of national health costs.
They are then working to develop standardized examinations at the national level – for non-physician practitioners – which will lead to a federal diploma. Since 2015, naturopaths in the fields of homeopathy, Ayurveda, traditional Chinese medicine and traditional European medicine have been able to obtain a diploma recognized throughout the country.
“It is always useful to have uniformity because the health insurance funds are a little slow in reimbursing care within the framework of complementary medical insurance. They are also under pressure to cut costs,” says Franz Rutz, president of the Swiss umbrella association of Ayurveda practitioners.
The introduction of the federal diploma has also prompted many cantons – such as Lucerne – to introduce or reintroduce work permits for naturopaths. To obtain one, naturopaths must provide their personal contact information and a copy of their federal diploma.
Opportunities and Challenges
Official accreditation means that those who earn a federal degree in naturopathy are exempt from value-added tax (VAT). They are also automatically included in the National Register of Health Professions and considered health workers: a big step forward from marginality.
“With a cantonal work permit, we are included in the primary healthcare system, for example now during the Covid-19 crisis we are allowed to continue working,” says Alexandra Nievergelt, co-chair of the Professional Organization Swiss Traditional Chinese Medicine, noting that naturopaths must also follow the same rules and restrictions as doctors amid the coronavirus.
She says the work license has also allowed alternative medicine practitioners to participate in health projects with other medical professionals, which was not possible before.
On the other hand, the transition to a cantonal authorization system raises questions about the fate of those who do not have a federal diploma and therefore cannot obtain a license to practice.
“We welcome a cantonal work permit for the future, as it helps to ensure that only qualified practitioners work in our field,” says Nievergelt. “Nevertheless, we would of course like to ensure that current practitioners are still able to continue working.”
Lucerne has proposed giving practitioners a five-year cushion to earn their federal degree but some are unhappy taking exams even after gaining decades of experience in their field. Disagreements over the exam have also led to offshoot groups among practitioners. For example, Ayurveda in Switzerland is now represented by four different associations and two schools because practitioners disagree on which way to go.
But it seems that it is too late for those who oppose licensing, because the tide has already turned in favor of the standardization and homogenization of alternative medicine in Switzerland. Acupuncturists already need a license in 20 of Switzerland’s 26 cantons and Ayurvedic therapists need one in 18 cantons (although most French-speaking cantons do not).
“It’s about clarifying the quality of practitioners. They must have the proper training, be able to make an accurate diagnosis, and be competent in administering health treatments,” says Rutz.
Alternative medicine: insurance and diplomas
Five alternative therapies – homeopathy, holistic, herbal and neural therapies and traditional Chinese medicine – are included in Swiss basic health insurance. Treatment costs are only reimbursed by the basic insurance if they are administered by a doctor.
The cost of all other alternative and complementary therapies will only be reimbursed if the patient opts for separate supplementary health insurance which costs more. However, not all disciplines are recognized by insurers.
Two types of federal degrees in alternative medicine are offered. The advanced level is that of a naturopath where degree holders can diagnose ailments and prescribe treatments such as herbal preparations. Recognized disciplines include homeopathy, traditional Chinese medicine and traditional European medicine. Practitioners holding this naturopathic diploma can obtain a cantonal work permit.
The second category of federal diploma is that of complementary therapist. Holders provide specialized treatments like oil massages to people who are healthy or have minor ailments, but they are not authorized to diagnose illness. Disciplines recognized by the government include yoga, shiatsu, craniosacral therapy and eutony.
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