In 1992, the Federal German Ministry of Research and Technology initiated an extensive research programme on complementary/alternative medicine coordinated by the University of Written/Herdecke (172).
Three-fourths of allopathic physicians use complementary/alternative medicine and 77% of pain clinics provide acupuncture treatments (172).
In 1994, there were between 10 000 and 13 000 practitioners of complementary/alternative medicine, or Heilpraktikers, 8000 of whom were members of professional associations (172). There are approximately 40 chiropractors practising in Germany.
There were 20 million patient contacts with complementary/alternative medicine in 1992. The most frequently sought complementary/alternative therapies are, in order of popularity, homeopathy (accounting for 27.4% of patient contacts), acupuncture (15.4%), procaine injection therapy, chiropractic, ozone and oxygen therapy, herbal medicines, humoural pathology, massage, and cell therapy (172).
According to a 1992 poll (172), between 20% and 30% of the population had used complementary/alternative medicine, with 5% to 12% having used it during the previous year. Complementary/alternative therapies are more popular with women than men. Most complementary/alternative patients are between the ages of 18 and 65 and have a relatively high level of education. In most cases, patients have first sought treatment with allopathic medicine.
There are many organizations for practitioners and patients of complementary/alternative medicine.
In Germany, there is no legal monopoly on the practice of medicine (172). Thus, licensed non-allopathic physicians may practice medicine, and all licensed medical practitioners are allowed to use complementary/alternative medicine.
There are, however, some restrictions on the performance of particular medical acts. Only allopathic physicians and dentists are allowed to practise dentistry. Only allopathic physicians are allowed to treat sexual diseases, treat communicable and epidemic diseases, deliver specific medications, give or provide anaesthetics and narcotics, practise obstetrics and gynaecology, take X-rays, perform autopsies, and deliver death certificates. Infringement may result in penal punishment. In order to obtain a title as an allopathic physician, a person must have an academic degree in medicine, practical experience, a licence from public authorities, and a medical certificate confirming that there are no indications of physical or mental disability or addiction to drugs.
Licensed Heilpraktikers (172) may practise medicine with the exclusion of these specific medical acts. To qualify for a Heilpraktiker's licence, a candidate must be at least 25 years old, have German or European Union citizenship, have completed primary school, have a good reputation in order to guarantee a normal professional practice, have a medical certificate confirming that there are no indications of physical or mental disability or addiction to drugs, and pass an examination before a health commission proving that the candidate has sufficient knowledge and ability to practise as a Heilpraktiker and that the candidate's treatments do not negatively affect public health. The exam verifies the candidate's basic knowledge of anatomy, physiology, hygiene, pathology, sterilization, disinfecting, diagnosis, and health regulations, particularly the epidemic law. However, the questions are required to be basic and understandable.
Chiropractors must obtain a Heilpraktiker licence regardless of whether or not they have a degree from an accredited institution (65).
Education and training
As part of the standard curriculum, allopathic medical schools are required to test students on their knowledge of complementary/alternative medicine. Students may also select a postgraduate specialization in complementary/alternative medicine (172). Heilpraktiker candidates do not have to follow standardized training in order to pass the licensing exam, which has resulted in a wide variety of teaching methods as well as variations in the length and quality of training. According to a recent poll, only 10% of Heilpraktikers did not have any form of training, while 88% had from one to four years of training (172).
The German Federal Association of Heilpraktikers organizes training in 29 cities for persons who desire to obtain a Heilpraktiker licence. Some of this training lasts three years or 350 hours (172).
In Germany, the title "Homeopathic Physician" is legally protected. The Medical Chamber bestows this title after a three-year training programme (86). Advanced obligatory training courses for homeopathic professors are given on a regular basis. Official homeopathic teaching contracts exist with the medical faculties in Berlin, Dusseldorf, Hannover, Heidelberg, and Freiburg (53). Chiropractors holding a degree from a regionally accredited institution may use the title "Doctor of Chiropractic" (65).
In Germany, public and private insurance (172) provides the same kind of coverage. Both currently reimburse some complementary/alternative treatments and are moving towards broadening this coverage. Even though there is no constitutional right to obtain reimbursement, the following criteria have been established to determine the coverage of complementary/alternative medicine by both social insurance and private insurance:
• If no allopathic treatment is available to treat a specific illness or to reduce its pain or if the aetiology is unknown - for example, for multiple sclerosis or certain forms of cancer - the use of complementary/alternative medicine is reimbursed provided the treatment has a minimum chance of success whether or not the method of treatment is generally scientifically recognized.
• If the aetiology is known, but no allopathic treatment is available, the recourse to complementary/alternative medicine is allowed, provided there is a minimum chance of success according to the aetiology. The same allowance is given when a previous allopathic treatment has been unsuccessful.
• When an allopathic treatment and a complementary/alternative treatment are both available but the allopathic treatment has side effects or risks for the patient, in general or in particular, the use of complementary/alternative medicine is reimbursed. However, in this case, it is necessary to balance the risks and the cost-effectiveness of the treatment.
• If there are safe allopathic and non-allopathic treatments at a patient's disposal, he/she may choose the less expensive treatment.
Anthroposophic, phytotherapeutic, and homeopathic products are reimbursed. By Articles 92 al. 1 and 135 al. 1 Sozialgestezbuch, in order to be reimbursed, experimental treatments have to be recognized, in broad terms, as useful and safe.
Some private insurance companies also reimburse treatments not scientifically recognized if they are provided by Heilpraktikers and if their effectiveness is not completely rejected.