(2004; 109 pages)
2.2 Health system structure
The structure of the health system in the country is important for the development of information about TM/CAM as it may determine the need for information as well as the kind of information suitable for different groups (2).
The extent to which TM/CAM is an officially recognized element of health care depends largely on the structure of the health system in individual countries. WHO has identified three types of health system structures in relation to TM/CAM: an integrative health system, an inclusive health system and a tolerant health system (2).
In an integrative health system (e.g. China, the Republic of Korea and Viet Nam) TM/CAM is officially recognized and incorporated into all areas of health care provision. There are a series of regulations and registration to control the safety, efficacy and quality of herbal medicine products. The TM doctors must receive a university education which includes both knowledge of TM and modern medicine, and they must be licensed to practise. Patients/consumers are free to consult both TM/CAM providers and medical doctors, the health insurance system covers both forms of treatment, and there are no communication barriers between TM/CAM practitioners and medical doctors. In addition, the government often provides consumer education. (See Annex I for an example of consumer information developed by the Department of Health, Hong Kong SAR, China.) The benefit of an integrative health system is that many of the necessary elements that are important when promoting proper use of TM/CAM already exist.
The other systems are an inclusive health system, which recognizes TM/CAM, but has not yet incorporated it into all aspects of health care (e.g. in health care delivery, education and training, regulation or research). This situation exists in many countries including Australia, Canada, Germany, Ghana, India, Indonesia, Iran, Madagascar, Malaysia, Mali, Singapore, Switzerland, Thailand, Ukraine, United Arab Emirates and the United States. In a tolerant health system, health care is based entirely on conventional medicine and TM/CAM practices are not officially recognized as therapeutic methods or as health enhancement practices within the national health care system. At present, most countries have a health system structure that belongs to this third category (2). The type of information developed will have to address the specific needs demanded by the individual health system.