News – New regulation found after the CAMbrella deliveries:
The French government has on September 12, 2014 (322) and December 12, 2014(323) decided two new decrees on standards of osteopathic training required to practise as an osteopath in France.
The French government has on March 24, 2014, with consolidated versions February 5, 2015 (324, 325, 326), decided three governmental decrees on the training of chiropractors and accreditation of training institutions in Chiropractic. One of the decrees includes regulations related to educational exemptions that could be granted for the preparation Diploma allowing using the title of chiropractor.
Notice! All text below is copied from the CAMbrella report – delivered Dec 31, 2012
In this summary, you will find:
- Direct links to the legislation of specific CAM therapies in France
- The legal and regulatory status of CAM and CAM practices in France
- The governmental supervision of CAM practices in France
- The reimbursement status of CAM practices and medicinal products in France
Go directly to legislation of specific CAM therapies in France:
Acupuncture – Anthroposophic medicine – Ayurveda – Chiropractic – Herbal medicine/Phytotherapy –
Homeopathy – Massage – Naprapathy – Naturopathy – Neural therapy – Osteopathy – Traditional Chinese Medicine (TCM) – Other treatments
France was a founding member of the European Union (EU) in 1952 (11), and a founding
member of the Council of Europe on 5 May 1949 (12).
The legal and regulatory status of CAM and CAM practices
There is no CAM law in France (43, 106). Only legally regulated personnel may treat patients, and by that only medically qualified professionals are allowed to practise CAM (43, 106). Acupuncture, anthroposophic medicine and homeopathy are regulated by the medical association and osteopathy is statutory regulated by the government (106, 110).
In the later years the practice of chiropractic, osteopathy and acupuncture are by the medical orders considered as “responsible professional conduct”(43). Other health professionals provide treatment according to regulations provided by the State
Council decree issued after consultation with the National Academy of Medicine (111).
Teaching complementary/alternative medicine to physicians is permitted. Private schools, however, may not issue diplomas to their graduates. According to Article 4 of the Act of 18 March 1880, only the State has this power (44).
The University of Bobigny established the Department of Natural Medicines in 1982. Since then, diplomas have been awarded in acupuncture, homeopathy, phytotherapy, osteopathy, auriculotherapy, naturopathy, oligotherapy, and mesotherapy and from 1990, the University Diploma in Natural Medicines (44).
In addition to the medical acts usually reserved for physicians, the following is strictly
restricted to physicians:
- All manipulations of joints, enclosing slipped disc, osteopathy, vertebral therapy and
- Specific physiotherapeutic acts (112).
The governmental supervision of CAM Practices
The Ministry of Health includes a directorate of social security who is supervising social
security organizations including the health insurance funds and schemes (112). According to “Le code de santé publique” (The Code of Public Health), article L4161-1, “persons other than licensed physicians who habitually or continuously diagnose or treat illnesses, real or supposed, or who perform activities constituting medical procedures are illegally practising medicine” (28, 111).
Supervision is managed by two types of professional organizations:
- Professional associations for doctors, pharmacists, dentists and midwives who are
concerned with medical ethics and the supervision of professional practice.
- Trade unions looking after the interests of different professional groups (112).
Doctors, dental surgeons and pharmacists are self-regulated through their professional
organizations at national and department level, in terms of professional ethics and the right to practice (112).
The National Agency for Accreditation and Health Care Evaluation (ANAES)
is responsible for issuing and disseminating recommendations and practice guidelines and for assisting doctors in evaluating their practices (112).
The reimbursement status of CAM practices and medicinal products
The health insurance schemes are under the supervision of the Social Security Directorate of the Ministry of Social Security. Every year the parliament passes an Act on Social Security (112).
The 2001 Act improved the benefits provided by the health insurance scheme for selfemployed people, aligning them with those provided by the health insurance scheme for salaried workers. The 2002 Act has renewed an agreement between the health insurance funds and health care professionals’ organizations.
Consultation with a statutorily recognized healthcare practitioner is free of charge (70).
Acupuncture, homeopathy and massage is reimbursed by the national insurance system
(acupuncture treatment by national and private insurance, consultation with an
anthroposophic physician is partially covered by national and private insurance
Homeopathic remedies are partly reimbursed (35%) by the basic
national insurance system. Specific medical activities and products are covered, including chiropractic, medical phytotherapy consultations, and complementary/alternative technical sessions with an approved kinesiotherapist (44).
11. EUROPA. Gateway to the European Union; member countries. Brussels EUROPA
Communication department of the European Commission; 2011 [cited 2011 November 3]; Available from: http://europa.eu/about-eu/countries/index_en.htm.
12. Council of Europe. Council of Europe. Strasbourg: Council of Europe; 2011 [cited 2011
November 7]; Available from: http://www.coe.int/lportal/web/coe-portal.
28. ECH (European Committee for Homeopathy). ECH in European Countries. Brussels: ECH; 2011 [cited 2011 September 12]; Available from: http://www.homeopathyeurope.org/countries.
43. Ersdal G, CAM-CANCER consortium. How are European patients safeguarded when using complementary and alternative medicine (CAM)? Jurisdiction, supervision and reimbursement status in the EEA area (EU and EFTA) and Switzerland. Tromsø: NAFKAM, University of Tromsø 2005 28 October Report No.: Report CAM 21.11.05-1.doc.
44. Legal Status of Traditional Medicine and Complementary/Alternative Medicine : A Worldwide Review [database on the Internet]. World Health Organization. 2001 [cited 9 March 2010]. Available from: http://whqlibdoc.who.int/hq/2001/WHO_EDM_TRM_2001.2.pdf, http://hinfo.humaninfo.ro/gsdl/whohss/1.00.0000/en/d/Jh2943e/.
70. ECCH. The Legal Situation for the Practice of Homeopathy in Europe; Revised Edition 2009. European Council for Classical Homeopathy (ECCH), 2009 May 2006. Report No.: 2009.
106. CAMDOC Alliance ECH ECPM ICMART and IVAA. The regulatory status of Complementary and Alternative Medicine for medical doctors in Europe. Brussels 2010 January 2010. Report No.: 2010.
110. Robard I. Lesgislation et médecines complémentaires appelée aussi médecines alternatives ou médecines douces. 2012 [cited 2012 March 7]; Available from: http://www.bio-sante.fr/legislationet-medecines-complementaires.html , http://www.soleil-levant.org/presse/article.php3?id_article=679.
111. Legifrance. Code de la santé publique. Legifrance.gouv.fr: Legifrance; 2012 [cited 2012 March 7]; Available from: http://www.legifrance.gouv.fr/affichCode.do?cidTexte=LEGITEXT000006072665&dateTexte=20120306#.
112. Sandier S, Paris V, Polton D. Health Care Systems in Transition: France. In: Thomson S, Mossialos E, editors. Copenhagen: WHO Regional Office for Europe, on behalf of the European Observatory on Health Systems and Policies; 2004. p. 1–168.
322. La ministre des affaires sociales de la santé et des droits des femmes, La ministre de l’éducation nationale de l’enseignement supérieur et de la recherche, La secrétaire d’Etat chargée de l’enseignement supérieur et de la recherche. Décret n° 2014-1043 du 12 septembre 2014 relatif à l’agrément des établissements de formation en ostéopathie, English: Decree No. 2014-1043 of 12 September 2014 on the approval of training institutes in osteopathy. Legifrance.gouv.fr 2014 [cited 2015 February 5]; Available from: www.legifrance.gouv.fr/affichTexte.do;jsessionid=?cidTexte=JORFTEXT000029449275&dateTexte=&oldAction=dernierJO&categorieLien=id.
323. Le Gouvernement de France. JORF n°0289 du 14 décembre 2014 page 21048 texte n° 30 Arrêté du 12 décembre 2014 relatif aux dispenses d’enseignement susceptibles d’être accordées en vue de la préparation au diplôme permettant d’user du titre d’ostéopathe NOR: AFSH1426479A ELI:. Legifrance.gouv.fr 2014 [cited 2015]; Available from: www.legifrance.gouv.fr/eli/arrete/2014/12/12/AFSH1426479A/jo/texte.
324. Le Gouvernement de France. Décret n° 2014-367 du 24 mars 2014 relatif à la formation des chiropracteurs et à l’agrément des établissements de formation en chiropraxie NOR AFSH1325173D JO du 26/03/2014 texte : 0072;12 pages 5952/5953. English: Decree No. 2014-367 of 24 March 2014 on the training of chiropractors and chiropractic accreditation of training institutions NOR AFSH1325173D OG 03.26.2014 text: 0072; 12 pages 5952/5953. Legifrance.gouv.fr 2014 [cited 2015 6 February]; Available from: www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000028775083.
325. Le Gouvernement de France. Arrêté du 24 mars 2014 relatif aux dispenses d’enseignement susceptibles d’être accordées en vue de la préparation au diplôme permettant d’user du titre de chiropracteur NOR: AFSH1325189A Version consolidée au 05 février 2015. English: Decree of 24 March 2014 relating to educational exemptions could be granted for the preparation Diploma allowing to use the title of chiropractor NOR: AFSH1325189A Consolidated version February 5, 2015. Legifrance.gouv.fr 2014 [updated 5 February 2015; cited 2015 February 5]; Available from: www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000028775154.
326. Le Gouvernement de France. Arrêté du 24 mars 2014 relatif à la formation des chiropracteurs et à l’agrément des établissements de formation en chiropraxie NOR: AFSH1325188A Version consolidée au 05 février 2015: English: Decree of 24 March 2014 on the training of chiropractors and accreditation of training institutions Chiropractic NOR: AFSH1325188A Consolidated version of 5 February 2015 Legifrance.gouv.fr 2014 [cited 2015 5 February ]; Available from: www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000028775134