Go directly to legislation of specific CAM therapies in Hungary:
Acupuncture – Anthroposophic medicine – Ayurveda – Chiropractic – Herbal medicine/Phytotherapy – Homeopathy – Massage – Naprapathy – Naturopathy – Neural therapy – Osteopathy – Traditional Chinese Medicine (TCM) - Other treatments
Hungary declared itself an independent republic on October 23, 1989 (139). Hungary became a member of the European Union in 2004 (11) and of the Council of Europe on November 6, 1990 (12).
The legal and regulatory status of CAM and CAM practices
Comprehensive changes in the national and regional health legislation has been introduced in Hungary over the last decade (140). In Hungary CAM legislation is integrated in the public health system and all CAM providers must be a part of the official health system (140).
All CAM practitioners must have a licence to practise; for MD-s a university exam, and for no-MD-s an education in health care and a licence to practise from the Hungarian Further Education institute for nurses and other health providers (140). Medical acupuncture, traditional Chinese medicine, neural therapy, antroposophic medicine, ayurvedic medicine and manual medicine have been accepted as post graduate courses (2 year study period) since 1997. A final exam performed at medical universities is accepted as a licence for specialist practise in those medical fields (141).
The comprehensive CAM legislation came into force on 1 July, 1997(139, 142, 143, 144). The Act CLIV of 1997 on Health institutionalized the “National health promotion programme” with the principles “health for all” and “equal access to health services”(139, 144). The Act on Health (144), the Governmental Decree on CAM (143) and the Decree of the Ministry of Social Welfare on the practice of CAM (142) confirm a definition of CAM treatment, regulate the scope of CAM treatments, and state that “non-conventional procedures that substitute conventional therapy shall only be applied under the supervision of a physician”(28, 140,144).
The CAM legislation from 1997 (142) regulates the following CAM treatments; acupuncture, chiropractic, homeopathy, naprapathy, naturopathy, osteopathy, and phytotherapy. CAM physicians and practitioners must have a licence to practise according to regulations. The non-medical practitioners have to be official registered members of the public health system. The CAM law is under reconstruction by the Ministry of Health and the revised version is expected to be passed in 2012.
Hungary follows the tradition of detailed regulation of practitioners and treatments; consequently each CAM treatment has been included in the public health system and legislation with regulation of education, licences, authorization etc. (140). Act XXVIII of 1994 made membership of the Hungarian Medical Chamber compulsory for practising physicians and dentists. The Chamber of Non-medical Health Professionals (2003/13) was established to extend professional self-regulation to other qualified health care workers (139). The Chambers are responsible for the follow-up of CAM regulations (139).
There are three categories of authorized medical practitioners in Hungary; physicians, practitioners with a non-academic higher health qualification and other practitioners (43). In 2011 a wide range of CAM treatments were regulated in detail and most medical universities and schools offer training courses. Only physicians are allowed to practise acupuncture, anthroposophic medicine, ayurvedic medicine, chiropractic, homeopathy, manual medicine, traditional Chinese medicine (TCM), traditional Tibetan medicine and Kneipp practices (28, 50). Acupressure, kinesiology, shiatsu (in complementary moving and massage therapies), phytotherapy and reflexology may be provided by practitioners (nonmedical doctors)(50).
The University of Pécs is the unique CAM educational institution for medical doctors in Hungary (141). All providers of CAM in Hungary must take a 2 year education in CAM and pass a licence exam. Medical doctors are offered continuing medical education (CME) mostly at universities; non-MD practitioners take courses mostly at the Institute of Continuing Education for health workers in registered evaluated courses. The CAM Department of the University of Pécs provides education, controls and exams. Studies are offered for MDs only, and the following treatments are examples of courses provided: acupuncture, TCM, manual medicine (chiropractic, osteopathy), neuraltherapy, anthroposophic medicine, life-style adviser (140).
Courses at other educational institutions offer studies for non-medical providers (= natural healers, additionally part of the health system) for courses like acupressure, reflexology, NADA (detoxification), eye training, herbal medicine, kinesiology, complementary moving and massage therapies, complementary physiotherapies (Kneipp courses, electro, magneto, UV e.t. practice)(140).
Health practitioners (non-medical educated practitioners) may offer CAM treatments like; acupressure, reflexology, NADA (detoxification), eye training, herbal medicine, kinesiology, complementary moving and massage therapies, complementary physiotherapies (Kneipp courses, electro, magneto, UV e.t.) practice (4).
National CAM legislation regulates health products and the use, practice and education of
CAM. However, CAM non-medical practitioners (herbalist, many non-MDs, and acupressure therapist and others) are not regulated by the state. The Provincial and Territorial Government Agency regulates and controls regional health care practitioners. This public health system constitutes a heterogeneous regulation system in Hungary and challenges the CAM legislation (141). Legislative review and re-organization in several provinces have resulted in the establishment of permanent mechanisms for regulation of CAM practitioners including possible statutory self-regulation as health care practitioners in the future (141).
The governmental supervision of CAM Practices
The national government of Hungary exercise statutory supervision of health services, including the Health Insurance Fund (HIF)(144). The National CAM Supervisor Committee has the right to control and punish. Regulated CAM providers are included in the governmental supervisor Head Physician-system (141).
The reimbursement status of CAM practices and medicinal products
The Health Insurance Fund (HIF) and the National Health Insurance Fund Administration (NHIFA) contract with health care providers and reimburse them according to various payment methods (139). Act XCVI of 1993 on Voluntary Mutual Insurance Funds is the legal platform for private non-profit health insurance (139). Act LXXXIII of 1997 define treatments excluded from reimbursement by the national health insurance fund.
Among others are treatments not proved effective in improving health (1997/8), and recreational purposes massage (1997/11)(139). CAM is partially covered; massage, acupuncture, manual medicine, neuraltherapy in state hospitals or state outpatients surgeries have an agreement with NHIFA. Insurance is, however, mostly covered by additional private insurance companies (140).
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.
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.
139. Gaál P. Health Care Systems in Transition: Hungary:. In: Riesberg A, editor. Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies; 2004.
140. Ministry of Health, Hegyi G. Meeting with MOH in Budapest and Gabriella Hegyi: PTE Pecs University Medical School CAM Departm, Chair of CAM Department, President of Hungarian Medical Acupuncture Association, Secretary of CAM Advisory Committee of Health Minister. Budapest 2010.
141. Hegyi G. Meeting and emails: CAM in Hungary 2010. Budapest 2010.
142. 11/1997 (V.28.) NM rendelet a természetgyógyászati tevékenység gyakorlásának egyes kérdéseiröl (Decree of the Ministry of Social Welfare on the practice of CAM), The government of Hungary(1997).
143. 40/1997(III.5.) Korm.rendelet a természetgyógyászati tevékenységröl (Governmental decree on CAM), The Parliament of Hungary(1997).
144. Törvény az egészségügyról; (Health Law, act CLIV/16 of 1997, (spesific section 104), (1997).