Germany | Cam-Regulation

Germany

Summary of the country's general legislation of CAM.

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

Germany was a founding member of the European Union (EU) in 1952 (11) and became a member of The Council of Europe on 13 July 1950 (12).

The legal and regulatory status of CAM and CAM practices

CAM given by non-physicians has been legally regulated in Germany since 1939 by the
passing of the “Heilpraktikergesetz” (HeilprG), which also established the protected title
“Heilpraktiker” (120, 121). According to the Heilpraktiker act practitioners of homeopathy must be registered after passing an exam administrated by local healthcare authorities in order to prove that they possess sufficient knowledge in medicine and healthcare legislation (50, 121).

The HeilprG states among others that:

  • §1 Whoever wants to practise medical treatments without being accredited as a
    medical doctor needs a special permission.
  • §2 Medical science/treatment in the meaning of the law is every kind of activity,
    which is practised as a profession, directed at diagnosing, treating or relieving
    illnesses, sicknesses, or disabilities in humans, also if they are practised in the service
    of others.
  • §3 A person who has practised medical science/treatment at a professional level up
    to date and plans to continue to do so, will receive permission in accordance to the
    rules of the implementing regulations (121).

In order to practise medicine or carry out specialty training in Germany, all physicians must be in possession of a valid full or temporary licence to practise (122). The “Bundesärztekammer” offers additional certificates in some CAM treatments, so called ”Zusatzbezeichnungen”, treatments are naturopathy, acupuncture, homeopathy, manual medicine , physiotherapy.

Only medical doctors and Heilpraktikers (non-medically qualified practitioners) are allowed to provide CAM treatments, but there are restrictions on the performance of particular medical acts (28, 41). Only medical doctors are allowed to treat sexually-transmitted, communicable and epidemic diseases, deliver specific medications, give or provide anaesthetics and narcotics, practise obstetrics and gynecology, take X-rays, perform autopsies and issue death certificates (28, 123).

A Heilpraktiker(non-conventional health practitioner) must meet certain criteria, pass a public exam and register in order to get the licence to practice (41). According to the HeilprG, implementing provisions §2 (120), permission is not granted:

  • If the applicant has not yet reached the age of 26 (a).
  • If he/she does not have German citizenship (b).
  • If he/she cannot prove at least completion of primary education (d).
  • If it appears that he/she lacks moral reliability, especially heavy criminal or ethical misconduct(f).
  • If, in terms of health he/she is unfit to practise (g).
  • If it can be assumed with certainty that he/she is practising medicine in addition to any other profession (h).
  • If a review of the knowledge and skills of the applicant by the Health Department indicates that the practice of medicine by the person would mean a danger to the Public Health (i).

Acupuncture, anthroposophic medicine, homeopathy and naturopathy are legally regulated as therapeutic systems (28). The Medicines Act have accredited treatment forms in homeopathy, anthroposophy, and phytotherapy in a special law called “Besondere Therapierichtungen“, “Special treatment directions” (124).

The governmental supervision of CAM Practices

The medical associations focus on regulation of the professional practice and specify requirements for CME training, the professional code of conduct and routines for accusations of medical malpractice (125). Breach of regulations for treating patients may result in penalties (28). The health insurance companies are supervised by the state (125).

The reimbursement status of CAM practices and medicinal products

The statutory health insurance system (SHI) (since 2009 funded by the “Gesundheitsfonds”) manages the covering of health care services in Germany. Physicians must be approved and registered as “SHI physicians” to bill the statutory health insurance companies for treatment of patients (125).

The state insurance companies reimburse partly acupuncture (only for chronic knee pain due to osteoarthritis and for chronic low back pain), homeopathic and anthroposophic treatment performed by contracted (SHI) qualified medical doctors, but patients must pay for medicines (41, 106, 125). Anthroposophic medicine is also reimbursed by private insurance companies (106). Some private insurance companies cover homeopathic remedies and acupuncture (106).

The health insurance will pay the costs for normal physiotherapy sessions, but most likely the patient will co-pay for the osteopathy part of it.

From 2012 a new law (GKV-Versorgungsstrukturgesetz)(126) came into effect. The law allows the statutory health insurances to offer additional benefits to its customers. E.g. the Technical Krankenkasse (TK) decided to take over costs of up to 100€ per year and per insured person for homeopathic, phytotherapeutical and anthroposophic medicinal products which are obtainable only in pharmacies, but without a prescription.

Sources

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.

41. ECHAMP. Homeopathy and anthroposophic medicine in the EU: Facts and Figures 2011 (Third edition). In: European Coalition on Homeopathic and Anthroposophic Medical Products, editor. Third ed. Brussels: ECHAMP E.E.I.G.; 2011.

50. ECCH. The Legal Situation for the Practice of Homeopathy in Europe; An ECCH report; Oct 2010; Revised Edition 2011,. Brussels: European Central Council of Homeopaths 2010.

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.

120. Die Reichsregierung Deutschland. “Erste Durchführungsverordnung zum Gesetz über die berufsmäßige Ausübung der Heilkunde ohne Bestallung (Heilpraktikergesetz) in der im Bundesgesetzblatt Teil III, Gliederungsnummer 2122-2-1, veröffentlichten bereinigten Fassung, die zuletzt durch Artikel 2 der Verordnung vom 4. Dezember 2002 (BGBl. I S. 4456) geändert worden ist”. 2002 [cited 2012 March 6]; Available from: http://www.gesetze-iminternet.de/bundesrecht/heilprgdv_1/gesamt.pdf.

121. Die Reichsregierung Deutschland. Gesetz über die berufsmäßige Ausübung der Heilkunde ohne Bestallung (Heilpraktikergesetz); Ausfertigungsdatum: 17.02.1939. (Law on the professional practice of Medicine without appointment (medical Practitioners); HeilprG: “Heilpraktikergesetz in der im Bundesgesetzblatt Teil III, Gliederungsnummer 2122-2, veröffentlichten bereinigten Fassung, das zuletzt durch Artikel 15 des Gesetzes vom 23. Oktober 2001 (BGBl. I S. 2702) geändert worden ist”. 1939 [cited 2012 March 4]; Available from: http://www.gesetze-iminternet.de/heilprg/BJNR002510939.html.

122. Die Bundesärtzekammer Deutschland. Work and training in Germany 2012 [cited 2012 March 7]; Available from: http://www.bundesaerztekammer.de/page.asp?his=4.3575.

123. Des Bundesrates Deutschland. Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen (Infektionsschutzgesetz – IfSG), 5. Abschnitt, §24. Zuletzt geändert durch Art. 1 G v. 28.7.2011 I 1622. Bundesministerium des Justiz; 2000 [cited 2012 March 16]; Available from: http://www.gesetze-im-internet.de/ifsg/BJNR104510000.html.

124. Bundesministerium für justis Deutschland. Medicinal Products Act: Gesetz über den Verkehr mit Arzneimitteln (Arzneimittelgesetz – AMG) Ausfertigungsdatum: 24.08.1976 Vollzitat: ”Arzneimittelgesetz in der Fassung der Bekanntmachung vom 12. Dezember 2005 (BGBl. I S. 3394), das zuletzt durch Artikel 13 des Gesetzes vom 22. Dezember 2011 (BGBl. I S. 2983) geändert worden ist”. 1976 [updated 22 December 2011; cited 2012 March 7]; Available from: http://www.gesetzeim-internet.de/englisch_amg/englisch_amg.html#AMGengl_000G1.

125. Döring A, Paul F. The German healthcare system. The EPMA Journal. 2010;1(4):535-47.

126. Der Bundestag Deutschland. Gesetz zur Verbesserung der Versorgungsstrukturen in der gesetzlichen Krankenversicherung (GKV-VStG). Bundesgesetzblatt Jahrgang 2011, Teil I, Nr. 70. .Bundesanzeiger Verlag 2011 [cited 2012 March 16]; Available from: http://www.bgbl.de/Xaver/start.xav? startbk=Bundesanzeiger_BGBl&bk=Bundesanzeiger_BGBl&start=//*%5B@attr_id=%27bgbl111s2983.pdf%27%5D.

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