Background information

The Ministry of Social Affairs and Health recognizes the increasing contribution of complementary/alternative therapies to the Finnish Health Care System (172). Among older rural Finns, massage, bonesetting, and cupping are popular; among younger urban Finns, natural medicine, manipulation, acupuncture, and hypnosis are popular (172).

Statistics

About 50% of the adult Finnish population have used complementary/alternative medicine at least once (172). There are 30 chiropractors practising in Finland (45). In 1987, there were 200 local health centres providing acupuncture treatment (172).

Regulatory situation

Act 559 of 28 June 1994 (176) regulates the licensing of medical practitioners. By Article 4, the right to practise as an independent allopathic medical doctor can be granted to practitioners who have completed basic medical training and who have additional training in primary health care or special training in an allopathic medical speciality. Professional allopathic medical providers who fulfil the required conditions have a number of rights, including the right to use a protected occupational title.

Only allopathic doctors and, by Decree 564/1994 (172), registered chiropractors, naprapaths, and osteopaths are recognized health practitioners and allowed to practise medicine - specifically, to diagnose patients and charge fees. However, according to Act 559, other medical practitioners may treat patients if they do not practise within public services and do not pretend to be health care professionals. As a result, only allopathic doctors and registered chiropractors, naprapaths, and osteopaths are supervised by the medical authorities in practising complementary/alternative medicine. Other medical practitioners are not supervised, nor is their licensing regulated.

While anyone can use an unqualified title, such as "Chiropractor", by Act 559 only registered chiropractors, naprapaths, and osteopaths may use the descriptor "Trained" in describing themselves. Act 559 also confers title protection to allopathic physicians. Articles 34 and 35 of Act 559 relate to the illegal practice of medicine, punishable by fine or up to six months in prison, although prosecution is rare. The objective of these articles is to protect patients and medical professionals working within public services.

A licence is necessary to market homeopathic products with a degree of dilution less than one million.

Education and training

Since 1975, acupuncture has been an accepted part of allopathic medical practice, and training in acupuncture is a component of the medical curriculum of allopathic physicians (172).

Chiropractors, naprapaths, and osteopaths must complete at least four consecutive years of training approved by the National Board of Medico-Legal Affairs. Chiropractors generally train in the United States. Other complementary/alternative therapists often attend schools in Sweden (172).

Insurance coverage

When provided by an allopathic physician, acupuncture is covered by the Social Insurance Institution (SII) (172). In general, other complementary/alternative therapies are also reimbursed by the SII, provided they are given by medically qualified allopathic doctors during their normal sessions and provided the doctors do not specify which treatment they used. The SII covers treatments given by recognized chiropractors, naprapaths, and osteopaths when the following conditions are met:

• Patients can show that they first obtained a diagnosis and statement of required treatment from a licensed allopathic physician.

• Patients are referred to the complementary/alternative therapist by a licensed allopathic physician.

• The complementary/alternative therapist works in an institution led by a physiotherapist or an allopathic physician.

Complementary/alternative medications, however, are not covered by the SII.

In Finland, no private insurance companies (172) reimburse complementary/alternative medicine except in some cases of chiropractic treatment, where reimbursement follows the same criteria used by the SII.