Go directly to legislation of specific CAM therapies in Norway:
Acupuncture – Anthroposophic medicine – Ayurveda – Chiropractic – Herbal medicine/Phytotherapy – Homeopathy – Massage – Naprapathy – Naturopathy – Neural therapy – Osteopathy – Traditional Chinese Medicine (TCM) - Other treatments
Norway has been a member of EFTA (The European Free Trade Association) since 1960 (215) and a founding member of the Council of Europe since 1949 (12).
The legal and regulatory status of CAM and CAM practices
From 2003, the provision of CAM in Norway is regulated by Act No.64 of 27 June 2003: Alternative treatment of disease, illness, etc (Lov om alternativ behandling av sykdom mv). This act defines CAM as a health-related service which is provided more often outside than inside the official health care system.
The Norwegian regulation of CAM recognizes that it can be provided by both medical and non-medical professionals, as well as within or outside of the official health care system. The treatment’s efficacy and level of documentation does not affect whether it should be considered CAM or not. No specific CAM practitioners or treatments are mentioned.
Though no licence, authorization or formal demonstration of medical competence is required to provide CAM, the Act No.64 reserves treatment of some health conditions and the execution of some procedures for medically qualified health professionals.
Complementing this act, Norway has two national regulations related to the provision of CAM:
- FOR-2003-12-11-1500 Regulation of a voluntary registration system for practitioners of alternative treatment (Forskrift om frivillig registerordning for utøvere av alternativ behandling)
This regulation fulfills Section 3 in the Act No.64, detailing procedures for listing in the official ALTBAS registry, which is meant to improve patient’s safety as well as professionalism among CAM practitioners. Listing does not imply any form of recognition of the CAM provider or his/ her therapies by Norwegian health authorities.
- FOR 2003-12-11 nr 1501: Regulation related to marketing of alternative treatment of disease (Forskrift om markedsføring av alternativ behandling av sykdom)
This regulation details Section 8 in the Act No.64, regarding CAM providers’ marketing and use of professional titles. The regulation is meant to ensure patient’s safety by keeping marketing of CAM services and providers unbiased and fact-oriented.
The governmental supervision of CAM Practices
According to the Norwegian Supervision Act (222), medically qualified health professionals who provide CAM are supervised as health personnel. This supervision is carried out by the Norwegian Board of Health Supervision (Helsetilsynet).
Treatment provided by non-medically qualified CAM practitioners generally falls within the jurisdiction of the Criminal Act, though Act no 64 provides specific penal provisions, regarding:
- Sections 5, 6 and 7 of the Act restricts treatment considered as possibly hazardous for patient’s health; treatment for serious communicable diseases; or other serious diseases and disorders, only to be practised by authorized health professionals (216).
- Further, non-authorized CAM providers who willfully or through gross negligence place a person’s life or health in serious danger, may be punished - either because of the treatment itself or because the patient as a result of the treatment omits to seek expert help. Misunderstanding the danger or the nature of the disease does not exempt the CAM provider from responsibility and punishment.
Supervision of the marketing of CAM and non-medically qualified health providers’ use of titles is described in the FOR 2003-12-11 nr 1501 Regulation related to marketing of alternative treatment of disease (220), and carried out by the Norway's official Consumer Authority. Main points here are:
- Non-medically qualified CAM providers may not use titles that might confuse them with medically qualified health professionals, or give the impression that they represent the official health care system.
- CAM providers’ marketing of their services may not give the impression that their treatments are effective.
- CAM providers may not market treatment directed at patients/ conditions regulated by Sections 5,6 and 7 in the Act No 64.
The government does not take responsibility for claims for compensation after injuries sustained by CAM treatment from non-medically qualified CAM providers. If the CAM provider is medically qualified and the CAM treatment is considered adequately integrated into the relevant treatment offered by the official health care services, the Act on Patient Injury Compensation (Pasientskadeloven) may be applicated and such compensation covered.
For example, claims following an injury sustained during acupuncture treatment from a physiotherapist may be covered, if it is in line with and considered an integral part of physiotherapy treatment usually given inside the official health care system. However, if a medically qualified professional mainly offers CAM treatment outside the official health services, such claims will not be covered by this Act. This will be especially true if the status as an medically qualified health professional is used in the promotion of the CAM treatment. The governmental agency Norwegian System of Patient Injury Compensation (NPE) offers specific assessments about this topic to healthcare providers.
CAM providers who have listed themselves in the official ALTBAS registry are required to have a company listed in the Register of Business Enterprises; hold a membership in a government-approved practitioner's organization; and must have a valid liability insurance against any claims for injuries sustained in their CAM practise. Listing in ALTBAS is voluntary.
Along with the passing of the Act No.64 and the two regulations, Norwegian health authorities have decided to contribute to patient safety via research and public, unbiased information. For this purpose, the National Research Center in Complementary and Alternative Medicine (NAFKAM) was founded. NAFKAM is located at the Faculty of Health at UiT The Arctic University of Norway and financed by the Norwegian Directorate of Health. NAFKAM is a WHO Collaboration Center for Traditional and Complementary Medicine. In addition to conducting research, NAFKAM runs the open-access information web sites CAM Cancer, CAM Regulations and NAFKAM.no.
The reimbursement status of CAM practices and medicinal products
Expenses for CAM treatment provided by non-medically qualified CAM providers is not reimbursed by the National Insurance Scheme (Folketrygden). Yet private health insurance is not widely used in Norway, some insurance companies offers insurance which reimburse the expense of specific CAM treatments, regardless whether the provider is medically qualified or not.
Expenses for over-the-counter (OTC) health products such as dietary supplements, homeopathic/ antroposophic remedies and non-prescription, plant-based drugs are not reimbursed. Homeopathic/ anthroposophic remedies are regulated as drugs, meaning that they are only available in pharmacies.
Costs for CAM treatment by medically qualified health professionals is usually not covered, but may be reimbursed if the CAM treatment is considered adequately integrated with conventional treatment and given inside the official healthcare system; such as acupuncture treatment from a midwife for relieving pain during labour inside the hospital; or the use of needles from a physiotherapist as a part of regular physiotherapy treatment.
215. EFTA. EFTA through the years EFTA (The European Free Trade Association); 2011 [cited 2011 November 8]; Available from: http://www.efta.int/about-efta/history.aspx.
216. LOV-2003-06-27-64 Lov om alternativ behandling av sykdom mv : English: Act relating to the alternative treatment of disease, illness, etc, Helse- og omsorgsdepartementet, 2002-2003 Sess. (2003).
217. Helsedepartementet. Ot.prp. nr. 27 (2002–2003) Om lov om alternativ behandling av sykdom mv. Oslo: HOD (Helse- og omsorgsdepartementet); 2002. p. 228
218. FOR-2003-12-11-1500 Forskrift om frivillig registerordning for utøvere av alternativ behandling; (English translation unauthorized: Regulation on public register for providers of alternative treatment), (2003).
219. LOV-1999-07-02-64 Lov om helsepersonell m.v. (helsepersonelloven- hlspl) HOD (Helse-og omsorgsdepartementet)(1999).
220. FOR 2003-12-11 nr 1501: Forskrift om markedsføring av alternativ behandling av sykdom: (English translation unauthorized: Regulation related to marketing of alternative treatment of disease) (2003).
221. Ministry of Health and Care Services. Norwegian Directorate of Health. Oslo 2011 [cited 2011 October 1 ]; Available from: http://www.regjeringen.no/en/dep/hod/About-the-Ministry/Subordinate-institutions/the-directorate-for-health-and-social-af.html?id=213297.
222. Lov- 1984- 03-30-15 Lov om statlig tilsyn med helsetjenesten, HOD (Helse- og omsorgsdepartementet) (1984).
223. The Norwegian Directorate of Health. The Norwegian Health Economics Administration’s web site (HELFO). Oslo: The Norwegian Directorate of Health; 2011 [cited 2011 October 31]; Available from: http://www.helfo.no/omhelfo/Sider/about-helfo.aspx.