Background information

The private sector ensures the availability of complementary/alternative medicine (172). The Societa Italiana di Omeopatia, founded in 1947, links the different societies and schools of homeopathy (172).

Statistics

Of Italy's 250 000 allopathic physicians, 5000 use complementary/alternative techniques. Of those using complementary/alternative techniques, around 1300 practise acupuncture (172). There are approximately 200 chiropractors practising in Italy (65).

Twenty-four per cent of adults have used complementary/alternative medicine at least once. Women, particularly those between 25 and 50 years of age, are the most likely to use complementary/alternative medicine (172). In order of popularity, homeopathy, acupuncture, herbal remedies, prana therapy, anthroposophic medicine, and chiropractic are the most popular complementary/alternative therapies (172).

More than three million people, 5.25% of the population, use homeopathy. Ninety-two per cent of these patients are female, 79% are adults, and 69% are middle class. There are about 5000 homeopathic doctors, 7000 pharmacies selling homeopathic products, and 20 companies that produce or distribute homeopathic medicines. The market for homeopathic products in Italy grew from 10 billion lira in 1982 to 120 billion lira in 1994 (177). In September 1996, a petition enclosing 300 000 signatures of patients of homeopathic medicine asked the Italian Parliament to give official recognition to homeopathy (172).

Regulatory situation

In order to practice as an allopathic physician (172), a person must have a degree in medicine or surgery, must have passed the corresponding State exam, and must be registered in a professional register. Paramedics are specifically excluded from practicing complementary/alternative medicine. According to a decision by the Criminal Supreme Court of Appeals in Perugia, only registered allopathic physicians may practice complementary/alternative medicine. Allopathic physicians using complementary/alternative, rather than allopathic, techniques are responsible for any consequences to their patients. Allopathic physicians are not permitted to aid or cooperate with non-allopathic practitioners to illegally provide medical care of any kind.

However, the courts have also ruled that chiropractic is a profession, even though it is not licensed (65). Chiropractors are considered medical auxiliaries rather than medical specialists and must work under the supervision of an allopathic doctor.

Complementary/alternative practitioners who are not also allopathic physicians can be prosecuted under Article 348 of the Italian Penal Code, although this rarely occurs (172). Indeed, the Criminal Supreme Court of Appeals in Perugia's decision noted that even if acupuncture is taught in Italian universities, only physicians and surgeons are allowed to practise it. The Court considers medical and/or surgical expertise necessary to establish an exact diagnosis and avoid prejudicial consequences to patients.

Law 175 of 5 February 1992 (172) expressly prohibits the use of titles that are not recognized by the State. No forms of complementary/alternative medicine are recognized as medical specialities under this law.

Specific regulations on complementary/alternative medicine currently cover only homeopathy and anthroposophic medicine (177). Homeopathy has a long history in Italy; attempts to regulate it began in the middle of the nineteenth century. On 17 March 1995, legislative Decree 185 was adopted, executing Directive 92/73/CEE, which regulates the marketing and registration of homeopathic and anthroposophic products.

Education and training

Acupuncture training (172) is available for both allopathic physicians and non-allopathic physicians. Some anaesthesiology programmes include specialities in acupuncture. The University of Catania, Sicily, offers a postgraduate programme in acupuncture. The Society of Italian Acupuncturists and the Paracelse Institute also offer training. The latter is a member of the World Federation of Acupuncturists and Moxibustion Society. However, training programmes in complementary/alternative medicine, even when offered at the university level, are not legally recognized.

Insurance coverage

Each Italian region has its own regulations on the reimbursement of health care (172). In Lombardy, for example, there is a co-payment of 70 000 Italian lira for complementary/alternative medicine. The National Health Service pays the remainder. When provided by an allopathic doctor holding a university medical degree, acupuncture, hypnosis, antalgic lasertherapy, pressing massotherapy, lymphatic drainage, reflexive massotherapy, biofeedback, and vertebral manipulation and other articulation massage are reimbursed.

Since the Italian Government is working to reduce National Health Service expenses, this information is likely to change soon (172).

Not all private insurance programmes (172) reimburse complementary/alternative medicine services. Those that do vary in the amount they reimburse and they generally require treatments to be provided by allopathic physicians, except in the case of articulation manipulation. Insurance premiums vary according to the age, sex, and health status of the patient. They are approximately 500 000 Italian lira annually for a child and 1 500 000 Italian lira annually for an adult.