New regulation found after the CAMbrella deliveries:
Switzerland 29 March 2016 Press release from the Swiss Federal Office of Internal Affairs (EDI). The public vote of 2009, and the article 118a in the Swiss constitution will be fulfilled. Anthroposophic medicine, classical homeopathy, herbal medicine (Phytotherapy) and non-acupuncture TCM, practised by certified Medical Doctors (MDs) will be permanently included in KVG (krankenversicherung) of compulsory Health Insurance (OKP). The decision is restricted until end of 2017, but will enter into force definitely by 1 May 2017 if no serious obstacles before 30 June, 2016 (277) (332)
Go directly to legislation of specific CAM therapies in Switzerland:
Acupuncture – Anthroposophic medicine – Ayurveda – Chiropractic – Herbal medicine/Phytotherapy – Homeopathy – Massage – Naprapathy – Naturopathy – Neural therapy – Osteopathy – Traditional Chinese Medicine (TCM) - Other treatments
Switzerland is a Federal State composed of the federal level, 26 Cantons and the municipals (274). Switzerland is an EFTA member state since 1966 with bilateral agreements to EEA (215) and joined the Council of Europe in 1963 (12).
The legal and regulatory status of CAM and CAM practices
Regulation of the Swiss healthcare system is decentralized (274) and the legislative authority in the cantons is a unicameral parliament (275). In principle, each Canton has its own regulations for health practice, but there are some federal regulations (276).
Complementary medicine is included in the Federal Constitution of the Swiss Confederation Art. 118a 52 since 2009; “The Confederation and the Cantons shall within the scope of their powers ensure that consideration is given to complementary medicine” (277).
The cantons have a high degree of independence regarding licensing of the health professions, authorizations to open a medical practice or pharmacy and the structure of healthcare services (275). The regulatory power of the federal government over the health care system is increasing. The Federal Health Act became effective on 1 January 1996 (278) and from 18 April 1999 the new federal constitution confirmed the federal responsibility for the training of health related professionals other than doctors (275).
By definition, Swiss CAM is divided in two terms: Complementary Medicine (CM) is reserved for Medical Doctors’(MD’s) practices, whereas Alternative Medicine (AM) dominates nonmedically trained practitioners’ practices (276).
Federal law defines criteria for a medical profession. (Updated Federal Law on Medical Professions (MedBG) is expected in 2012). Regulations include MD’s and non-medically trained practitioners’ education, training, certification, and Continuous Medical Education(CME). For MDs, the latter is delegated to the Swiss Association of Medical Doctors („Foederatio Medicorum Helveticorum“, FMH), for CM it is delegated to the respective CM associations. Most insurance companies delegate non-medically trained practitioners’ certification to a private registry of experience medicine (“Erfahrungsmedizinisches Register“, EMR). Practice establishment is regulated by the Cantons for both, MDs, and non-medical practitioners (276).
The governmental supervision of CAM Practices
Licensed CM practice by MDs is restricted to certified MDs with an additional and certified CM qualification, to be renewed (CME) every 3 years (106, 276).
Registered non-medical professionals’ practice will be regulated in 2013. Currently, in 6 Cantons there are almost no regulations at all (free setting-of practice), whereas in other Cantons (eg. Berne), strict regulations, similar to MD practices, exist.
The reimbursement status of CAM practices and medicinal products
The ‘Gemeinsame Einrichtung KVG’ (Common Institution under the Fed. Health Insurance Act) was established by the insurers when the Federal Health Act became effective on 1 January 1996 (4). In 1999 compulsory health insurance (OKP) was introduced by passing The Health Insurance Law (2).
Reimbursement MD practices
Acupuncture treatment is reimbursed (included in KVG) from 1 July 1999 (279).
Five CM disciplines, practised by certified CM physicians, were included in KVG temporarily, 1 July 1999 – 30 June 2006: Anthroposophic Medicine, Classical Homeopathy, Herbal Medicine (Phytotherapy), Neural Therapy, and non-acupuncture TCM. In that time period cost reimbursement of these CM disciplines was restricted to additional insurances (VVG) in a similar way as generally non-medical AM practices. Since 1 July 2011, local and segmental Neural Therapy is permanently included in KVG. Neural Therapy according to Huneke („Störfeldtherapie“, interference field therapy) is still restricted to additional insurances (VVG). Due to a referendum (17 May 2009) Anthroposophic Medicine, Classical Homeopathy, Herbal Medicine (Phytotherapy) and non-acupuncture TCM, practised by certified MDs, are again temporarily included in KVG of compulsory health insurance (OKP) in the period from 1 January 2012 up to 31 December 2017. Regulations are based on proof of efficacy as well as clinical- and cost-effectiveness (276, 279). The Physicians’ association of Neural Therapy according to Huneke withdrew their attempt for temporary implementation on 4 November 2011.
Reimbursement of non-certified disciplines or practices of MDs, (partially) trained in CM or AM, are restricted to additional insurances (VVG), according to individual contracts or paid out-of-pocket (276).
Reimbursement non-medically trained professionals’ practices
Cost reimbursement of most (registered) non-medical AM practices is restricted to
additional insurances (VVG) according to a nation-wide registry (EMR) of disciplines and nonmedical AM practitioners, and individual companies’ contracts. Some insurance companies also reimburse non-registered AM disciplines, and practices, according to individual contracts. Other non-medical AM practice is paid out-of-pocket (276).
Reimbursement medicinal products (see CAM medicinal product report)
CAM products, registered by Swiss Agency for Therapeutic Products (swissmedic) in a special list (“Spezialitäten-Liste“, SL), are reimbursed by KVG, whereas others are reimbursed due to individual contracts according to VVG or out-of-pocket (276).
2. Fønnebø V, Kristiansen Tunby T, Falkenberg T, Hegyi G, Hök J, Roberti di Sarsina P, Wiesener S. Deliverable 9 – report No. 2 – Herbal and homopathic medicinal products. In: Wiesener S, Fønnebø V, editors. CAMbrella project FP7-HEALTH-2009, GA No.241951; Work Package 2; Deliverable 9 – Legal status and regulation of CAM in Europe, 2012.
4. Treaty of Lisbon amending the Treaty on European Union and the Treaty establishing the European Community, signed at Lisbon, 13 December 2007, entered into force December 1, 2009, (2007).
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.
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.
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.
274. Berchtold P, Peytremann-Bridevaux I. Ten years of integrated care in Switzerland. International Journal of Integrated Care. 2011;11(5).
275. Minder A, Schoenholzer H, Amiet M. Health Care Systems in Transition:Switzerland. In: Dixon A, Mossialos E, editors. Copenhagen: WHO Regional Office for Europe, on behalf of the European Observatory on Health Systems and Policies; 2000. p. 1-90.
276. Klaus von Ammon. Email: WP2 Switzerland. Bern 2011
277. Federal Constitution of the Swiss Confederation of 18 April 1999 (Status as of 1 January 2011), The Parliament of Switzerland(1999).
278. The Gemeinsame Einrichtung KVG ( Common Institution under the Fed. Health Insurance Act) according to Art. 18 KVG: Institution for progress in the prevention of diseases according to Art. 19 KVG, Federal Constitution of the Swiss Confederation(2011)
332. Verordnung über die Krankenversicherung (KVV) http://www.bag.admin.ch/themen/krankenversicherung/00305/16022/index.html?lang=de