The Dutch Association of Homeopathic Doctors was established in 1898 (172).
According to a 1985 study, 18% of the population has used complementary/alternative medicine at least once - 6% to 7% during the previous 12 months. In 1990, over 900 000 people consulted a complementary/alternative practitioner other than their own allopathic general practitioner (172). More women than men use complementary/alternative medicine, especially those between the ages of 35 to 50. Most patients treated with herbal medicines and by paranormal healing have little formal education; most patients of other forms of complementary/alternative medicine are executives and professionals (172).
The 1985 survey reported more than 4000 complementary/alternative practitioners in the Netherlands: 735 naturopaths, 300 paranormal healers, 220 homeopaths, 475 anthroposophical professionals (either allopathic doctors or other professionals, such as anthroposophical nurses), 945 acupuncturists, and 1450 manual therapists. There are 125 chiropractors practising in the Netherlands (45). In addition to these providers, according to a 1992 survey, almost half of Dutch general practitioners have provided complementary/alternative treatment at least once - 40% have used homeopathy, 9% manipulative medicine, 4% acupuncture, and 4% naturopathy (172).
The most popular forms of complementary/alternative medicine are, in order of popularity: homeopathy, herbal medicine, manual therapies, paranormal healing, acupuncture, diet therapy, naturopathy, and anthroposophical medicine (172). The most common conditions presented to complementary/alternative practitioners are musculoskeletal pain and complaints of nervous origin (172). Patients most often report that they use complementary/alternative therapy because allopathic methods are ineffective for their chronic disorders. Only 14% of patients seek complementary/alternative care without having first consulted an allopathic practitioner. In one survey of patients treated with complementary/alternative medicine, 56% said that their health condition improved quite a lot, 22% felt that some improvement had occurred, and 22% saw no improvement at all.
According to a consumer survey, about 80% of the Dutch population would like to have complete freedom of choice over their medical treatments; specifically, they would like health insurance schemes to recognize complementary/alternative medicine. Sixty per cent of the Dutch population is ready to pay higher insurance premiums in order to have this choice.
Since 1993, when the Medical Practice Act of 1865 was replaced by the Individual Health Care Professionals Act (172), non-allopathic providers have been allowed to practice medicine in the Netherlands. The new act came into force on 1 December 1997, bringing the legal status of non-allopathic practitioners in line with that of allopathic paramedics: they may practise medicine provided they do not perform specific medical acts reserved for allopathic physicians, except under the orders of an allopathic physician. Violation of this limited monopoly can be prosecuted. The medical acts reserved for physicians are surgical procedures, obstetric procedures, catheterizations and endoscopies, punctures and injections, general anaesthesia, procedures involving the use of radioactive substances and ionizing radiation, cardioversion, defibrillation, electroconvulsive therapy, lithotripsy, and artificial insemination.
The Individual Health Care Professions Act also introduces a system to protect the titles of a limited number of professional groups, with the possibility of creating new medical specialities under specific conditions. It also defines the training requirements necessary for registration as one of these medical professionals. The eight professions regulated are allopathic medical doctor, dentist, pharmaceutical chemist, health care psychologist, psychotherapist, physiotherapist, midwife, and nurse. While non-allopathic practitioners are not allowed to use these titles or to work in the national health services, procedures are now in place for them to obtain recognition for their speciality, including a protected title.
There are also legal registers in which qualified medical practitioners of homeopathy, herbal medicine, manual therapies (such as chiropractic and osteopathy), paranormal healing, acupuncture, diet therapy, naturopathy, and anthroposophical medicine are entitled to be registered once they satisfy specific legal requirements. This registration gives them the right to practice under a protected title, with the aim of insuring they are qualified in a specific field of health care (172).
Education and training
According to the Dutch Health Council, complementary/alternative medical institutions have organized a number of training courses, taken steps to develop standards of training and professionalism, and established national registration systems (172).
About 60% of the members of complementary/alternative professional organizations have undergone training in a field of allopathic medicine, often as a physician, physical therapist, or nurse (172). Introductory courses on complementary/alternative medicine are included in the curriculum of several Dutch medical schools (172). Allopathic doctors wishing to be trained in anthroposophical medicine, acupuncture, homeopathy, or manipulative therapy can attend part-time courses for one to four years. There are also postgraduate programmes for physical therapists, most of whom study acupuncture or manipulative therapy.
Without allopathic medical or paramedical training, individuals may register in one of the three academies for naturopathy offering full-time courses of three to four years (172). Students completing the three-year basic course in homeopathy earn the designation "Homeopathic Physician" (53). Registration must be renewed every five years, based on proof of participation in compulsory continuing-education courses. A disciplinary committee monitors and penalizes homeopathic malpractice.
Officially, only homeopathic and anthroposophic medicines are reimbursed by social insurance (172). However, private health insurance reimburses all care given by allopathic general practitioners, whether allopathic or complementary/alternative. Two-thirds of the population have private health insurance.
In 1988, all large private insurance companies (172) began covering homeopathy, acupuncture, and manipulative therapy as part of their standard or supplementary packages. In addition to the legally defined standard package, which is the same for all 45 health insurance funds, the funds also offer a supplementary package to which their clients can voluntarily subscribe. Under the supplementary coverage, 26 of the 45 health insurance funds reimburse some kinds of complementary/alternative medicine if provided by an allopathic physician or a physiotherapist, usually homeopathy, acupuncture, and anthroposophical treatments. In many cases, reimbursement was given only when care was provided by allopathic physicians or physical therapists who were members of a professional organization.
In 1991, in response to consumer demand, many packages were expanded to cover more types of complementary/alternative medicine and to cover care provided by non-allopathic practitioners. As of 1998, 47 private insurance companies cover between 25% and 100% of complementary/alternative treatments provided by allopathic physicians or members of professional organizations - to a maximum of 300 to 2500 Dutch florins per year. This coverage generally includes homeopathy, anthroposophy, acupuncture, manual therapies, chiropractic, naturopathy, and neuraltherapy.