Go directly to legislation of specific CAM therapies in Germany:
Acupuncture – Anthroposophic medicine – Ayurveda – Chiropractic – Herbal medicine/Phytotherapy – Homeopathy – Massage – Naprapathy – Naturopathy – Neural therapy – Osteopathy – Traditional Chinese Medicine (TCM) – Other treatments
Legal and regulatory status
In Germany, only health professionals holding a licence to practice medicine (e. g. medical doctors, dentists, psychotherapists, veterinarians) or registered non-medical practitioners, the so-called ‘Heilpraktiker’ can practise any form of medicine including complementary and alternative medicine (CAM).
Medically qualified health professionals are regulated by the Bundesärzteordnung. Medical doctors with medical specialisation need to obtain additional qualifications in CAM (‘Zusatzbezeichnungen’) e.g. naturopathy, acupuncture, chiropractic/manual therapy, or homeopathy in order to practise these therapies.
Heilpraktiker are regulated by the Heilpraktikergesetz of 1939, which establishes the title ‘Heilpraktiker’ and regulates their practice with an official permit. The Heilpraktikergesetz is the legal basis for the ‘Permission to practice medicine without being a medical doctor’. Additional regulations apply; Heilpraktiker are for example not allowed to treat notifiable or infectious diseases including sexually transmitted diseases, practise midwifery or dentistry, perform autopsy, or prescribe prescription medication. The Heilpraktikergesetz was last revised on 23rd December 2016.
In addition to the general EU regulations, phytomedicine, homeopathy and Anthroposophic medicine are regulated as particular therapeutic systems, ‘Besondere Therapierichtungen,’ in the Medicinal Products Act (‘Arzneimittelgesetz’). According to § 109a AMG, herbal medicinal products can be also marketed as “traditional herbal medicines” provided the product has been registered as such with the Federal Agency for Medicinal Products and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM). The assessment of their effectiveness is then exclusively based on traditional use. Homoeopathic Medicinal Products must be registered with the BfArM before a product can be marketed (secc. 39 of the Medicinal Products Act).
On the premise of pluralism in pharmacotherapy, the German Medicines Act explicitly postulates that the characteristics of the ‘particular therapeutic systems’ are to be respected. For this reason, the legislator has established specific commissions to provide medical expertise in the respective therapeutic fields.
Continuing professional development (CPD) of medical doctors including the above-mentioned additional training required to obtain the ‘Zusatzbezeichnung’ for CAM is regulated and supervised by the medical association (‘Ärztekammer’) of the respective state.
Heilpraktiker training is voluntary and not regulated but candidates need to pass an exam before a health commission in order to obtain a licence. To be admitted for the exam a candidate must, for example, be at least 25 years old, have no criminal record, have completed (primary) school ‘Hauptschulabschluss’, not suffer from chronic, infectious diseases or addiction. The exam is a certificate of compliance aimed at establishing whether a candidate possesses sufficient knowledge and skills as to not pose a threat to their patients or negatively affect public health. In 2018, the Ministry of Health published guidelines for assessing knowledge and skills of Heilpraktiker candidates, which form the basis of the exam.
There are an estimated 47,000 Heilpraktiker in Germany the majority of which are organised in numerous professional societies. These societies represent Heilpraktikers’ interests and educational events, some also run training courses/schools for Heilpraktiker candidates. Since 2011, five large Heilpraktiker societies collaborate under the umbrella association ’Dachverband Deutscher Heilpraktikerverbände’.
Reimbursement through statutory health insurance depends on the individual’s contract with the respective health insurer; the website Gesetzliche Krankenkassen.de provides an overview of coverage of CAM by the respective insurers. As a rule, statutory health insurance covers acupuncture for chronic knee and back pain (but not for other indications) and only if treatment is provided by a medical doctor (but not Heilpraktiker) with relevant additional qualifications (‘Zusatzbezeichnung’) in CAM.
Most statutory health insurance providers offer private supplementary insurance, which covers the costs of a Heilpraktiker. Some private health insurances reimburse CAM provided by a Heilpraktiker depending on the individual contract between the patient and the health insurer.
Some health insurers reimburse non-prescription medicines including herbal, homeopathic or anthroposophic products if they have been recommended by a physician using a so-called “green prescription” (‘grünes Rezept‘).