(2001; 200 pages)
According to a 1998 poll (172), almost 40% of the Belgian population - women more than men - have used complementary/alternative medicine at least once. Of these persons, 77% were satisfied with their treatment. While the general public is in favour of the Ministry of Health giving official recognition to homeopathy, acupuncture, osteopathy, and chiropractic, allopathic physicians are evenly divided: 43% are in favour and 43% are opposed to such recognition.
The most widely consulted complementary/alternative therapies in Belgium (172) are homeopathy, accounting for 81% of complementary/alternative consultations; acupuncture, accounting for 38%; osteopathy, 27%; phytotherapy, 25%; and chiropractic, 21%. One allopathic physician out of four believes that these therapies should be reimbursed. Fifty-nine per cent of patients who use complementary/alternative medicine and 36% of patients who do not use complementary/alternative medicine are willing to pay higher premiums to cover this reimbursement.
Most providers of complementary/alternative treatments are allopathic doctors or physiotherapists (172). One allopathic physician out of four provides complementary/alternative treatments; these are mostly general practitioners. The most commonly practised forms of complementary/alternative medicine are homeopathy, practised by 59% of providers of complementary/alternative medicine; acupuncture, practised by 40%; and phytotherapy, 28%. Thirty-three per cent of manipulative treatments are provided by physiotherapists and 34% by non-allopathic practitioners.
There are three homeopathic organizations for allopathic physicians and pharmacists and two for patients. The Union of Acupuncturists Physicians was created in 1981.
A monopoly on the practice of medicine was introduced by the Practice of Medicine Act of 1967 (172). Under this act, the practice of medicine, which includes diagnosis, treatment, prescriptions, surgery, and preventive medicine, was the exclusive domain of legally qualified allopathic physicians. After the intervention of the European Commission with regard to the (non)enforcement of European Directives on homeopathic products, the Government of Belgium asked the Federal Department of Public Health to draft legislation on complementary/alternative medicine. On 29 April 1999, the new law was adopted by the Belgian Parliament (175). In November 1999, the Government enacted bylaws to ensure enforcement of the law.
Article 2 of the new law introduces provisions for homeopathy, chiropractic, osteopathy, and acupuncture and provides for the recognition of other complementary/alternative techniques.
Article 3 establishes a commission to advise the Government on the practice of complementary/alternative medicine, particularly registration of practitioners, membership in recognized professional organizations, insurance for professionals, regulation of advertising, and restrictions on medical acts. In order to register, practitioners must demonstrate that they provide high-quality and accessible care that has a positive influence on their patients' health.
Article 6, Paragraph 1 requires the commission to be composed of five allopathic practitioners (with at least one being a general practitioner), nominated by faculties of medicine, and five complementary/alternative practitioners, nominated by recognized professional organizations. The commission, in Article 6, Paragraph 2, is also designated to advise the Government on organizing a peer-review system and a code of professional ethics.
By Article 8, the practice of a registered complementary/alternative form of medicine is allowed only when the practitioner is licensed for that practice by the Ministry of Social Affairs, Public Health, and Environment.
In Article 9, complementary/alternative practitioners are required to maintain medical records for each patient. Complementary/alternative practitioners who are not also allopathic physicians must obtain a recent allopathic physician's diagnosis from their patient prior to commencing treatment. If patients choose not to consult an allopathic physician before seeing a complementary/alternative practitioner, they must put their wishes in writing. Registered complementary/alternative practitioners must take precautions to ensure that patients are not deprived of allopathic treatment. As a result, complementary/alternative practitioners who are not also allopathic physicians must keep allopathic physicians informed of the health of their patients. With patient consent, complementary/alternative practitioners are permitted to seek the advice of other complementary/alternative practitioners who are not allopathic physicians.
Infringement of the law - in particular, practising complementary/alternative medicine without a licence or treating a patient without having obtained an allopathic physician's diagnosis or without having the patient's desire to avoid such diagnosis in writing - risks a fine (under Article 11) or the suspension or withdrawal of the provider's licence to practice (under Article 8).
Education and training
Complementary/alternative medicine is not taught in Belgian medical schools; however, the Belgian Medical Faculty of Homeopathy offers courses for allopathic physicians, surgeons, dentists, pharmacists, and veterinarians. These courses comply with standards set by the European Committee for Homeopathy (172).
The Belgian Acupuncture Federation is authorized by the Belgian Government to train acupuncturists to practise under the new licensing law (172). In order to be permitted to practise acupuncture, a provider must be certified as an allopathic medical doctor, dentist, physiotherapist, nurse, or midwife, as well as having completed at least 750 hours of acupuncture training - 250 hours of basic theoretical principles of traditional Chinese medicine, 250 hours of traditional Chinese medicine pathology, and 250 hours of clinical practice - and having written a thesis. There are two associations of acupuncturists offering three-year training programmes; however, most practitioners using acupuncture are trained in East Asia or France.
The Belgian social security system (172) does not officially reimburse complementary/alternative treatments, regardless of whether they are provided by allopathic physicians or not. Practically speaking, however, allopathic physicians using complementary/alternative medicine may assure their patients that at least part of their fees will be reimbursed. Osteopathic treatments are reimbursed so long as physiotherapists use a classic designation to prescribe them.
In March 1997, the Socialist Mutual Insurance of Tournai-Ath (172) was the first company to partially reimburse specific complementary/alternative treatments. They reimburse 25% of homeopathic remedies up to a maximum cost of 6000 Belgian francs per year and per beneficiary. They also reimburse 400 Belgian francs for each osteopathic treatment with a maximum of six treatments, but only if they have been provided by an allopathic physician, nurse, or physiotherapist. The list of reimbursed homeopathic remedies is adapted from the European Union Directive on homeopathic products. Reimbursement may soon be extended to other techniques, such as acupuncture and phytotherapy.
Private insurance companies (172) reimburse chiropractic care and, partially, acupuncture treatments.